Active NPI
Nico O Andrade
- Clinical Social Worker
- Malden, MA
National Provider Identifier
1275827586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 123199
- Practice address
- 105 Bainbridge St
Malden, MA 02148-2937 - Phone
- (617) 917-4823
- NPI assigned
- Jun 3, 2011
- Last updated
- Feb 7, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | ||
| Social Worker | 104100000X | 223054 | MA | |
| Clinical Social Worker | 1041C0700X | 123199 | MA | Primary |
Addresses
Primary practice location
105 Bainbridge St
Malden, MA 02148-2937
Mailing address
105 Bainbridge St
Malden, MA 02148-2937
Phone (617) 917-4823
Other practice location 1
49 Lyon St
Dorchester, MA 02122-2918
Phone (908) 437-2908
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 |
|---|---|---|---|
| 123199 | MA | MD | Clinical Social Worker |
| 223054 | MA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Davinci Behavioral Health | Clinical | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675728000000",
"number": "1275827586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 BAINBRIDGE ST",
"city": "MALDEN",
"state": "MA",
"postal_code": "021482937",
"telephone_number": "617-917-4823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 BAINBRIDGE ST",
"city": "MALDEN",
"state": "MA",
"postal_code": "021482937",
"telephone_number": "617-917-4823"
}
],
"practiceLocations": [
{
"address_1": "49 Lyon St",
"address_purpose": "LOCATION",
"city": "Dorchester",
"state": "MA",
"postal_code": "021222918",
"country_code": "US",
"telephone_number": "908-437-2908",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDRADE",
"first_name": "NICO",
"middle_name": "O",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-03",
"last_updated": "2023-02-07",
"certification_date": "2023-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "223054",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "123199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malden, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.