Individual provider Active NPI

Jill McNamara, LICSW

  • Clinical Social Worker
  • Waltham, MA
National Provider Identifier
1356826614
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
117885 Issued in MA
Practice address
77 4TH Ave Ste 500
Waltham, MA 02451-7559
Phone
(781) 693-1773
NPI assigned
Oct 2, 2018
Last updated
Oct 2, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

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 117885 MA Primary

Addresses

Primary practice location

77 4TH Ave Ste 500
Waltham, MA 02451-7559

Mailing address

77 4TH Ave Ste 5
Waltham, MA 02451-7567
Phone (781) 693-1773

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

LicenseStateTypeSpecialty
117885MAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1356826614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 4TH AVE STE 5",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024517567",
            "telephone_number": "781-693-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 4TH AVE STE 500",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024517559",
            "telephone_number": "781-693-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNAMARA",
        "first_name": "JILL",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "117885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.

Verify at the official NPI Registry.