Individual provider Active NPI

Gina Marie Gambardella, LICSW

  • Clinical Social Worker
  • Boston, MA
National Provider Identifier
1124163092
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1024099 Issued in MA
Practice address
25 Staniford St
Boston, MA 02114-2503
Phone
(617) 626-8649
NPI assigned
Feb 20, 2007
Sex
Female
Sole proprietor
No

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 1024099 MA Primary

Addresses

Primary practice location

25 Staniford St
Boston, MA 02114-2503

Mailing address

93 Myrtle Ave
Wakefield, MA 01880-4025
Phone (617) 626-8649

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
I20141205000666 MA Practitioner - Clinical Social Worker 1850613639 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
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)

20 Vining St
Boston, MA 02115-6115
Phone (617) 626-9300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1024099MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Commonwealth of Massachusetts CurrentSince Nov 7, 2011 Accepting new patients
The Commonwealth of Massachusetts CurrentSince Nov 7, 2011 Accepting new patients
The Commonwealth of Massachusetts Current Accepting new patients
Thrive Counseling LLC CurrentSince May 19, 2020 Accepting new patients

Locations

20 Vining St
Boston, MA 02115
Phone (617) 626-9300

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

25 Staniford St
Boston, MA 02114
Phone (617) 626-8500

872 Massachusetts Ave
Ste 2-2
Cambridge, MA 02139
Phone 6173804651 ext. 1992

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

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

Organizations & group practices 4

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": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124163092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 MYRTLE AVE",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018804025",
            "telephone_number": "617-626-8649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 STANIFORD ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142503",
            "telephone_number": "617-626-8649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBARDELLA",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1024099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.