Active NPI
Patricia Marie Moran-Queenan, LICSW
- Clinical Social Worker
- Bedford, MA
National Provider Identifier
1316420649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1017509-SW-LICSW
- Practice address
- 11 Walsh Rd
Bedford, MA 01730-2222 - Phone
- (781) 275-8098
- NPI assigned
- Sep 12, 2018
- 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 | 1017509-SW-LICSW | MA | Primary |
Addresses
Primary practice location
11 Walsh Rd
Bedford, MA 01730-2222
Mailing address
11 Walsh Rd
Bedford, MA 01730-2222
Phone (781) 275-8098
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1017509-SW-LICSW | Other | MA | LICENSE |
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 |
|---|---|---|---|
| 1017509-SW-LICSW | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536710400000",
"number": "1316420649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 WALSH RD",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017302222",
"telephone_number": "781-275-8098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 WALSH RD",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017302222",
"telephone_number": "781-275-8098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORAN-QUEENAN",
"first_name": "PATRICIA",
"middle_name": "MARIE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-12",
"last_updated": "2018-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1017509-SW-LICSW",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "1017509-SW-LICSW",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bedford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.