Individual provider Active NPI

Melissa J Dagher, LICSW

  • Social Worker
  • Dorchester, MA
National Provider Identifier
1073922001
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
120140 Issued in MA
Practice address
637 Washington St
Dorchester, MA 02124-3510
Phone
(617) 825-9660
Fax
(617) 288-7898
NPI assigned
Aug 4, 2014
Last updated
Jan 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 120140 MA Primary

Addresses

Primary practice location

637 Washington St
Dorchester, MA 02124-3510

Mailing address

637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660

Other identifiers 1

IdentifierTypeStateIssuer
110115698AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151001002177 MA Practitioner - Clinical Social Worker 3870801319

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
220139MAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Liberation Wellness Collective LLC Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1073922001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 WASHINGTON ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021243510",
            "telephone_number": "617-825-9660",
            "fax_number": "617-288-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 WASHINGTON ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021243510",
            "telephone_number": "617-825-9660",
            "fax_number": "617-288-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGHER",
        "first_name": "MELISSA",
        "middle_name": "J",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-04",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "120140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110115698A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester, MA

Sources for this page

Verify at the official NPI Registry.