Active NPI
Michael Grinnell
- Clinical Social Worker
- Jamaica Plain, MA
National Provider Identifier
1083082614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- S40690186
- Practice address
- 555 Amory St
Jamaica Plain, MA 02130-2652 - Phone
- (617) 522-0901
- NPI assigned
- Sep 14, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | S40690186 | MA | Primary |
Addresses
Primary practice location
555 Amory St
Jamaica Plain, MA 02130-2652
Mailing address
29 Montcalm Ave
Brighton, MA 02135-2839
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
| License | State | Type | Specialty |
|---|---|---|---|
| S40690186 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442188800000",
"number": "1083082614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 MONTCALM AVE",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "021352839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 AMORY ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302652",
"telephone_number": "617-522-0901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRINNELL",
"first_name": "MICHAEL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-14",
"last_updated": "2015-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "S40690186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.