NPIMap

Organization Active NPI

Sport Development Services Inc.

  • Clinical Social Worker
  • Boston, MA
National Provider Identifier
1396407284
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SPORT DEVELOPMENT SERVICES INC.
Practice address
19 Boyden St
Boston, MA 02124-3212
Phone
(781) 244-0894
NPI assigned
Oct 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Authorized official

Name
Mr. Floyd Ashton Williams-Agnew
Title
Founder/Executive Director/Mentor
Phone
(781) 244-0894

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

19 Boyden St
Boston, MA 02124-3212

Mailing address

19 Boyden St
Boston, MA 02124-3212

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL fawagnew@gmail.com

National Provider Directory

National Provider Directory
Tax ID family
Sport Development Services Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1396407284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BOYDEN ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021243212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BOYDEN ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021243212",
            "telephone_number": "781-244-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT DEVELOPMENT SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS-AGNEW",
        "authorized_official_first_name": "FLOYD",
        "authorized_official_middle_name": "ASHTON",
        "authorized_official_title_or_position": "FOUNDER/EXECUTIVE DIRECTOR/MENTOR",
        "authorized_official_telephone_number": "781-244-0894",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fawagnew@gmail.com",
            "affiliation": "N",
            "address_1": "19 Boyden St",
            "city": "Boston",
            "state": "MA",
            "country_code": "US",
            "postal_code": "021243212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.