Active NPI
Mary Minott, LICSW
- Clinical Social Worker
- Brookline, MA
National Provider Identifier
1164909057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 106227
- Practice address
- 115 Greenough St
Brookline, MA 02445-6151 - Phone
- (617) 713-5155
- NPI assigned
- Jul 24, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 106227 | MA | Primary |
Addresses
Primary practice location
115 Greenough St
Brookline, MA 02445-6151
Mailing address
1196 Central Ave
Needham, MA 02492-1653
Phone (161) 736-5705
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 11, 2024 through Jan 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106227 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532390400000",
"number": "1164909057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1196 CENTRAL AVE",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024921653",
"telephone_number": "161-736-5705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 GREENOUGH ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024456151",
"telephone_number": "617-713-5155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINOTT",
"first_name": "MARY",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-24",
"last_updated": "2018-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "106227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.