Individual provider Active NPI

Elizabeth Anne Rose

  • Clinical Social Worker
  • Georgetown, MA
National Provider Identifier
1295457653
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
125442 Issued in MA
Practice address
90 Pond St
Georgetown, MA 01833-1015
Phone
(978) 807-2492
NPI assigned
Sep 13, 2022
Last updated
Jan 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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 125442 MA Primary

Addresses

Primary practice location

90 Pond St
Georgetown, MA 01833-1015

Mailing address

90 Pond St
Georgetown, MA 01833-1015
Phone (978) 807-2492

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL office Health Information Exchange (HIE)
CONNECT URL office Direct

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
I20230207001724 MA Practitioner - Clinical Social Worker 9133591886 Practice locations: Georgetown, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1975
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

90 Pond St
Georgetown, MA 01833-1015
Phone (978) 807-2492

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
125442MAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1295457653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 POND ST",
            "city": "GEORGETOWN",
            "state": "MA",
            "postal_code": "018331015",
            "telephone_number": "978-807-2492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 POND ST",
            "city": "GEORGETOWN",
            "state": "MA",
            "postal_code": "018331015",
            "telephone_number": "978-807-2492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-13",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "125442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "office",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "90 Pond St",
            "city": "Georgetown",
            "state": "MA",
            "country_code": "US",
            "postal_code": "018331015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "office",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "90 Pond St",
            "city": "Georgetown",
            "state": "MA",
            "country_code": "US",
            "postal_code": "018331015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Georgetown, MA

Sources for this page

Verify at the official NPI Registry.