Individual provider Active NPI

Pamela M Bertolino, MSW

  • Clinical Social Worker
  • Lebanon, NH
National Provider Identifier
1346360724
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2750 Issued in NH
Practice address
1 Medical Center Dr
Lebanon, NH 03756-0001
Phone
(603) 650-5000
NPI assigned
Mar 30, 2007
Last updated
Jun 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 1018776 MA
Clinical Social Worker 1041C0700X C005646 NC
Clinical Social Worker 1041C0700X 2750 NH Primary

Addresses

Primary practice location

1 Medical Center Dr
Lebanon, NH 03756-0001

Mailing address

2781 Kipling Rd
Fuquay Varina, NC 27526-6169
Phone (919) 586-1002

Other practice location 1

817 W Front St
Peace of Mind Inc.,
Lillington, NC 27546-9735
Phone (910) 814-2197

Other identifiers 1

IdentifierTypeStateIssuer
6106621MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, NH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080424000380 NC Practitioner - Clinical Social Worker 6002880937 Reassigns benefits to 1 organization
Practice locations: Fuquay Varina, NC
I20230809000661 NH Practitioner - Clinical Social Worker 6002880937 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1018776MAMDSocial Worker
C005646NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Hitchcock Memorial Hospital Current Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Apr 16, 2024 Accepting new patients
Cheshire Medical Center CurrentSince Apr 16, 2024 Accepting new patients
Peace of Mind, Inc. CurrentSince Dec 7, 2017 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Jul 10, 2023 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Jul 10, 2023 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Jul 10, 2023 Accepting new patients

Locations

817 W Front St
Lillington, NC 27546
Phone (910) 814-2197

25 S River Rd
Bedford, NH 03110
Phone (603) 626-4392

253 Pleasant St
Concord, NH 03301
Phone (603) 226-2200

580 Court St
Keene, NH 03431
Phone (603) 354-5454

590 Court St
Keene, NH 03431
Phone (603) 354-5454

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Organizations & group practices 7

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": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1346360724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2781 KIPLING RD",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275266169",
            "telephone_number": "919-586-1002",
            "fax_number": "919-557-1018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "817 W Front St",
            "address_2": "Peace of Mind Inc.,",
            "address_purpose": "LOCATION",
            "city": "Lillington",
            "state": "NC",
            "postal_code": "275469735",
            "country_code": "US",
            "telephone_number": "910-814-2197",
            "fax_number": "910-814-2107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERTOLINO",
        "first_name": "PAMELA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "1018776",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005646",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "2750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106621",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.