Judith Radtke, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

100757 Issued in MA

Practice address

111 Perkins St Apt 125
Jamaica Plain, MA 02130-4333

Phone

(617) 522-0554

NPI assigned

Jan 13, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452643200000",
    "number": "1245696749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PERKINS ST APT 125",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021304333",
            "telephone_number": "617-522-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PERKINS ST APT 125",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021304333",
            "telephone_number": "617-522-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADTKE",
        "first_name": "JUDITH",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-13",
        "last_updated": "2016-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "100757",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "100757",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Quillen
• Ayanna Kai Quinones, PH.D.
• Shante Rabouin
• Mahendran Govind Radhakrishnan, LCSW
• Lauren Radigan, PHD
• Jenelle Marie Radzim
• Bonnie Rae
• Briana Elizabeth Rae, MA, SLP-CF
• Jill M Ragusa, MSW, LICSW
• Fariza Rahim, PHARMD

• Clinical Social Worker in Jamaica Plain, MA
• Providers in Jamaica Plain, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2016; 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.