Individual provider Active NPI

Jessica Ann Matos, LCSW

  • Clinical Social Worker
  • Brockton, MA
National Provider Identifier
1073917787
Registry record updated Oct 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
220143 Issued in MA
Practice address
15 Bolton PL
Brockton, MA 02301-5316
Phone
(508) 427-4383
Fax
(508) 584-4328
NPI assigned
Oct 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 220143 MA Primary

Addresses

Primary practice location

15 Bolton PL
Brockton, MA 02301-5316

Mailing address

32 Wellesley Dr
Somerset, MA 02726-3127
Phone (508) 558-9884

Other names 1

  • Jessica Ann Mello Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
220143MAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412812800000",
    "number": "1073917787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 WELLESLEY DR",
            "city": "SOMERSET",
            "state": "MA",
            "postal_code": "027263127",
            "telephone_number": "508-558-9884",
            "fax_number": "774-888-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 BOLTON PL",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015316",
            "telephone_number": "508-427-4383",
            "fax_number": "508-584-4328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATOS",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-09",
        "last_updated": "2014-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "220143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MELLO",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.