NPIMap

Individual provider Active NPI

Annette Kazibwe Nazziwa, LICSW

  • Clinical Social Worker
  • Roxbury, MA
National Provider Identifier
1154670248
Registry record updated Aug 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
120801 Issued in MA
Practice address
30 Dimock St
Roxbury, MA 02119
Phone
(617) 989-2938
Fax
(617) 445-9147
NPI assigned
Sep 5, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 120801 MA Primary
Clinical Social Worker 1041C0700X 218069 MA

Addresses

Primary practice location

30 Dimock St
Roxbury, MA 02119

Mailing address

30 Dimock St
Roxbury, MA 02119-1210
Phone (617) 989-2938

Other practice location 1

313 Congress St.,
Boston, MA 02210
Phone (617) 835-8411

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
120801MAMDClinical Social Worker
218069MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Malach Healthcare Clinical Current Accepting new patients
Valor Counseling and Consultation Services, LLC Clinical Current Accepting new patients
Valor Counseling and Consultation Services, LLC Current Accepting new patients

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": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533254400000",
    "number": "1154670248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 DIMOCK ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191210",
            "telephone_number": "617-989-2938",
            "fax_number": "617-445-9147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 DIMOCK ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "02119",
            "telephone_number": "617-989-2938",
            "fax_number": "617-445-9147"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "313 Congress St.,",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02210",
            "country_code": "US",
            "telephone_number": "617-835-8411",
            "fax_number": "617-790-4930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAZZIWA",
        "first_name": "ANNETTE KAZIBWE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2018-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "120801",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "218069",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roxbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.

Verify at the official NPI Registry.