Active NPI
Pamela Killen, LICSW
- Clinical Social Worker
- Nantucket, MA
National Provider Identifier
1265032189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 111346
- Practice address
- 63 Vestal St
Nantucket, MA 02554-2628 - Phone
- (508) 332-8934
- NPI assigned
- Oct 29, 2020
- 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 | 111346 | MA | Primary |
Addresses
Primary practice location
63 Vestal St
Nantucket, MA 02554-2628
Mailing address
63 Vestal St
Nantucket, MA 02554-2628
Phone (508) 332-8934
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 |
|---|---|---|---|
| 111346 | MA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shine Medical Providers PC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603929600000",
"number": "1265032189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 VESTAL ST",
"city": "NANTUCKET",
"state": "MA",
"postal_code": "025542628",
"telephone_number": "508-332-8934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 VESTAL ST",
"city": "NANTUCKET",
"state": "MA",
"postal_code": "025542628",
"telephone_number": "508-332-8934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLEN",
"first_name": "PAMELA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-29",
"last_updated": "2020-10-29",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "111346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nantucket, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.