Individual provider Active NPI

Rachel Anne Mervyn, LICSW

  • Clinical Social Worker
  • Boston, MA
National Provider Identifier
1285102970
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LICSW122919 Issued in MA
Practice address
780 Albany St
Boston, MA 02118-2755
Phone
(857) 654-1000
Fax
(857) 654-1100
NPI assigned
Nov 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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 LICSW122919 MA Primary

Addresses

Primary practice location

780 Albany St
Boston, MA 02118-2755

Mailing address

780 Albany St
Boston, MA 02118-2755
Phone (857) 654-1000

Other names 1

  • Rachel Anne Gannon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190617003079 MA Practitioner - Clinical Social Worker 2769715192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boston Health Care for the Homeless Program, Inc.Group PAC ID 2668475419, 75 clinicians

Practice addresses (Care Compare)

112 Southampton St
Boston, MA 02118-2711
Phone (617) 534-2881

17 Court St
Boston, MA 02108-2601
Phone (617) 371-1723

363 Albany St
Boston, MA 02118-2503
Phone (857) 654-1865

39 Boylston St
Boston, MA 02116-4702
Phone (617) 542-4704

444 Harrison Ave
Boston, MA 02118-2404
Phone (857) 654-1850

780 Albany St
Boston, MA 02118-2755
Phone (857) 654-1200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LICSW122919MAMDClinical Social Worker
122919MAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Health Care for the Homeless Program, Inc. CurrentSince May 5, 2019 Accepting new patients
Boston Health Care for the Homeless Program, Inc. CurrentSince May 5, 2019 Accepting new patients

Locations

780 Albany St
Boston, MA 02118
Phone (857) 654-1000

780 Albany St
#2130
Boston, MA 02118

Organizations & group practices 2

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": "1541980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1285102970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182755",
            "telephone_number": "857-654-1000",
            "fax_number": "857-654-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182755",
            "telephone_number": "857-654-1000",
            "fax_number": "857-654-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERVYN",
        "first_name": "RACHEL",
        "middle_name": "ANNE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-12",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW122919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHEL",
            "last_name": "GANNON",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.