Active NPI
Kristianna Penman, MSW
- Clinical Social Worker
- Medford, MA
National Provider Identifier
1376793554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 117051
- Practice address
- 10 Cabot Rd
Suite 209
Medford, MA 02155-5177 - Phone
- (617) 835-7256
- Fax
- (781) 395-0198
- NPI assigned
- Sep 24, 2008
- Sex
- Female
- Sole proprietor
- No
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 | 117051 | MA | Primary |
Addresses
Primary practice location
10 Cabot Rd
Suite 209
Medford, MA 02155-5177
Mailing address
10 Cabot Rd
Suite 209
Medford, MA 02155-5177
Phone (617) 835-7256
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 |
|---|---|---|---|
| 117051 | MA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eliot Community Human Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Malden, MA
- NPI 1356654560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579996800000",
"number": "1376793554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CABOT RD",
"address_2": "SUITE 209",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555177",
"telephone_number": "617-835-7256",
"fax_number": "781-395-0198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CABOT RD",
"address_2": "SUITE 209",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555177",
"telephone_number": "617-835-7256",
"fax_number": "781-395-0198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENMAN",
"first_name": "KRISTIANNA",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-24",
"last_updated": "2020-01-26",
"certification_date": "2020-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "117051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.