Individual provider Active NPI

Suzanne Etre, LICSW

  • Clinical Social Worker
  • Brighton, MA
National Provider Identifier
1316003056
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
111742 Issued in MA
Practice address
77B Warren St.
Bamha
Brighton, MA 02135-3601
Phone
(617) 787-1901
Fax
(617) 254-3461
NPI assigned
Dec 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 111742 MA Primary

Addresses

Primary practice location

77B Warren St.
Bamha
Brighton, MA 02135-3601

Mailing address

77B Warren St.
Bamha
Brighton, MA 02135-3601
Phone (617) 787-1901

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
I20141201001955 MA Practitioner - Clinical Social Worker 6103918594 Practice locations: Brookline, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1180 Beacon St
Suite 4B
Brookline, MA 02446-3834
Phone (617) 651-0260

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316003056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77B WARREN ST.",
            "address_2": "BAMHA",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353601",
            "telephone_number": "617-787-1901",
            "fax_number": "617-254-3461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77B WARREN ST.",
            "address_2": "BAMHA",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353601",
            "telephone_number": "617-787-1901",
            "fax_number": "617-254-3461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETRE",
        "first_name": "SUZANNE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MA

Sources for this page

Verify at the official NPI Registry.