Individual provider Active NPI

Jeff R Woodworth, LICSW

  • Clinical Social Worker
  • Jamaica Plain, MA
National Provider Identifier
1104041714
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1031169 Issued in MA
Practice address
180 Morton St
Jamaica Plain, MA 02130-3735
Phone
(617) 626-9359
NPI assigned
Apr 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 1031169 MA Primary

Addresses

Primary practice location

180 Morton St
Jamaica Plain, MA 02130-3735

Mailing address

28 Cedar Hill Dr
Westwood, MA 02090-1160
Phone (617) 626-9359

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
I20130114000186 MA Practitioner - Clinical Social Worker 1355594870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Commonwealth of MassachusettsGroup PAC ID 8820906860, 141 clinicians

Practice addresses (Care Compare)

75 Fenwood Rd
Boston, MA 02115-6103
Phone (617) 626-9300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1031169MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Commonwealth of Massachusetts CurrentSince Dec 3, 2012 Accepting new patients
The Commonwealth of Massachusetts CurrentSince Dec 3, 2012 Accepting new patients
The Commonwealth of Massachusetts Current Accepting new patients

Locations

75 Fenwood Rd
Boston, MA 02115
Phone (617) 626-9300

85 Newton St
Boston, MA 02118
Phone (617) 305-9960

180 Morton St
Jamaica Plain, MA 02130
Phone (617) 626-9300

76 Amory St
Roxbury, MA 02119
Phone (617) 626-9300

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104041714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 CEDAR HILL DR",
            "city": "WESTWOOD",
            "state": "MA",
            "postal_code": "020901160",
            "telephone_number": "617-626-9359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 MORTON ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021303735",
            "telephone_number": "617-626-9359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODWORTH",
        "first_name": "JEFF",
        "middle_name": "R",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1031169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica Plain, MA

Sources for this page

Verify at the official NPI Registry.