Maryellen Fairchild Collamore, LICSW, LCSW, MT-BC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

121357 Issued in MA

Practice address

380 Highland St
South Hamilton, MA 01982-1310

Phone

(978) 233-1226

NPI assigned

Sep 15, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Maryellen Fairchild Former name

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1124336920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 HIGHLAND ST",
            "city": "SOUTH HAMILTON",
            "state": "MA",
            "postal_code": "019821310",
            "telephone_number": "978-233-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 HIGHLAND ST",
            "city": "SOUTH HAMILTON",
            "state": "MA",
            "postal_code": "019821310",
            "telephone_number": "978-233-1226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1825 4th St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941432350",
            "country_code": "US",
            "telephone_number": "415-353-7982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLAMORE",
        "first_name": "MARYELLEN",
        "middle_name": "FAIRCHILD",
        "name_prefix": "Ms.",
        "credential": "LICSW, LCSW, MT-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-15",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "81865",
            "primary": false
        },
        {
            "code": "225A00000X",
            "taxonomy_group": "",
            "desc": "Music Therapist",
            "state": "PA",
            "license": "09139",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYELLEN",
            "last_name": "FAIRCHILD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in South Hamilton, MA
• Providers in South Hamilton, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.