Active NPI
Corissa Warzybok, LCSW, CCM
- Clinical Social Worker
- Cambridge, MA
National Provider Identifier
1083103998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 222148
- Practice address
- 163 Gore St
Cambridge, MA 02141-1119 - Phone
- (617) 575-5850
- NPI assigned
- May 7, 2018
- Sex
- Female
- Sole proprietor
- No
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 | 222148 | MA | Primary |
Addresses
Primary practice location
163 Gore St
Cambridge, MA 02141-1119
Mailing address
163 Gore St
Cambridge, MA 02141-1119
Phone (617) 575-5850
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 |
|---|---|---|---|
| 222148 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525651200000",
"number": "1083103998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 GORE ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021411119",
"telephone_number": "617-575-5850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 GORE ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021411119",
"telephone_number": "617-575-5850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARZYBOK",
"first_name": "CORISSA",
"credential": "LCSW, CCM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-07",
"last_updated": "2018-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "222148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.