Active NPI
Mark H Lipof, LICSW
- Clinical Social Worker
- Chestnut Hill, MA
National Provider Identifier
1205311883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1030149-SW-LICSW
- Practice address
- 1101 Lagrange St
Chestnut Hill, MA 02467-3066 - Phone
- (617) 469-0446
- NPI assigned
- Sep 28, 2018
- Sex
- Male
- 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 | 1030149-SW-LICSW | MA | Primary |
Addresses
Primary practice location
1101 Lagrange St
Chestnut Hill, MA 02467-3066
Mailing address
1101 Lagrange St
Chestnut Hill, MA 02467-3066
Phone (617) 469-0446
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1030149-SW-LICSW | Other | LICSW |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1030149-SW-LICSW | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538092800000",
"number": "1205311883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 LAGRANGE ST",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024673066",
"telephone_number": "617-469-0446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 LAGRANGE ST",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024673066",
"telephone_number": "617-469-0446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIPOF",
"first_name": "MARK",
"middle_name": "H",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-28",
"last_updated": "2018-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1030149-SW-LICSW",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICSW",
"identifier": "1030149-SW-LICSW",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Chestnut Hill, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.