Individual provider Active NPI

Dorothy K Soquist, LICSW

  • Clinical Social Worker
  • Vineyard Haven, MA
National Provider Identifier
1255579116
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
106899 Issued in MA
Practice address
124 Daggett Ave
Vineyard Haven, MA 02568-6406
Phone
(508) 693-5418
NPI assigned
Jan 30, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 106899 MA Primary

Addresses

Primary practice location

124 Daggett Ave
Vineyard Haven, MA 02568-6406

Mailing address

124 Daggett Ave
Vineyard Haven, MA 02568-6406
Phone (508) 693-5418

Other identifiers 1

IdentifierTypeStateIssuer
PO4429OtherMABC/BS

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

LicenseStateTypeSpecialty
106899MAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233273600000",
    "number": "1255579116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 DAGGETT AVE",
            "city": "VINEYARD HAVEN",
            "state": "MA",
            "postal_code": "025686406",
            "telephone_number": "508-693-5418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 DAGGETT AVE",
            "city": "VINEYARD HAVEN",
            "state": "MA",
            "postal_code": "025686406",
            "telephone_number": "508-693-5418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOQUIST",
        "first_name": "DOROTHY",
        "middle_name": "K",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2009-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "106899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "PO4429",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineyard Haven, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; 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.