Individual provider Active NPI

Cindy Sprouse, LICSW

  • Clinical Social Worker
  • Dorchester, MA
National Provider Identifier
1154308294
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
111807 Issued in MA
Practice address
250 Mount Vernon St
Dorchester, MA 02125-3120
Phone
(617) 288-1140
Fax
(617) 288-3910
NPI assigned
Dec 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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 111807 MA Primary

Addresses

Primary practice location

250 Mount Vernon St
Dorchester, MA 02125-3120

Mailing address

109 Curtis Ave
Apt #504
Quincy, MA 02169-7256
Phone (617) 786-3055

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
I20080825000310 MA Practitioner - Clinical Social Worker 9436224599 Reassigns benefits to 1 organization
Practice locations: Boston, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

185 Devonshire St
Suite 502
Boston, MA 02110-1407
Phone (617) 549-5579

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
111807MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Mental Health Center, Inc. CurrentSince Jun 16, 2008 Accepting new patients

Locations

1501 Washington St
Braintree, MA 02184
Phone (617) 745-2709

Organizations & group practices 1

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": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213315200000",
    "number": "1154308294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CURTIS AVE",
            "address_2": "APT #504",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021697256",
            "telephone_number": "617-786-3055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MOUNT VERNON ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021253120",
            "telephone_number": "617-288-1140",
            "fax_number": "617-288-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPROUSE",
        "first_name": "CINDY",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2008-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester, MA

Sources for this page

Verify at the official NPI Registry.