Sara Becker Goodliss, LICSW
Individual provider Active NPI Clinical Social Worker · Dover, MA
NPI 1225513161 · NPPES record last updated Sep 26, 2018
Key facts
- NPI
- 1225513161
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 116964 (MA)
- Practice address
- 21 Whiting Rd
Dover, MA 02030-2452 - Phone
- (617) 480-4708
- NPI assigned
- Sep 26, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116964 | MA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 116964 | MA | Yes |
Addresses
Primary practice location
21 Whiting Rd
Dover, MA 02030-2452
Mailing address
21 Whiting Rd
Dover, MA 02030-2452
Phone (617) 480-4708
NPI Registry JSON
{
"created_epoch": "1537920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537920000000",
"number": "1225513161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 WHITING RD",
"city": "DOVER",
"state": "MA",
"postal_code": "020302452",
"telephone_number": "617-480-4708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 WHITING RD",
"city": "DOVER",
"state": "MA",
"postal_code": "020302452",
"telephone_number": "617-480-4708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODLISS",
"first_name": "SARA",
"middle_name": "BECKER",
"name_prefix": "Mrs.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-26",
"last_updated": "2018-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "116964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.