Individual provider Active NPI

Phoebe Ward Gould Musico, LCSW

  • Clinical Social Worker
  • Fairfield, CT
National Provider Identifier
1386260040
Registry record updated Jun 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
009604 Issued in CT
Practice address
45 Pope St
Fairfield, CT 06825-4328
Phone
(203) 984-9352
NPI assigned
Jun 18, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2020

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 009604 CT Primary

Addresses

Primary practice location

45 Pope St
Fairfield, CT 06825-4328

Mailing address

45 Pope St
Fairfield, CT 06825-4328
Phone (203) 984-9352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20220418001510 CT Practitioner - Clinical Social Worker 6507253713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Fairfield, CT 06825
Phone (203) 457-3963

1201 Kings Hwy
Suite 2
Fairfield, CT 06824-5319

2900 Main St
Suite 3DF
Stratford, CT 06614-4946
Phone (203) 457-3963

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009604CTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Clearsource Counseling, PLLC Clinical CurrentSince Mar 29, 2022 Accepting new patients

Locations

1201 Kings Hwy
Ste 2
Fairfield, CT 06824
Phone (203) 521-1824

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.

NPI Registry JSON

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1386260040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 POPE ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068254328",
            "telephone_number": "203-984-9352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 POPE ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068254328",
            "telephone_number": "203-984-9352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSICO",
        "first_name": "PHOEBE",
        "middle_name": "WARD GOULD",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "009604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.