Active NPI
Michelle Tackitt, LICSW
- Clinical Social Worker
- Duxbury, MA
National Provider Identifier
1407221872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 119241
- Practice address
- 230 Chandler St
Duxbury, MA 02332-4233 - Phone
- (508) 830-0000
- NPI assigned
- Dec 10, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | 119241 | MA | Primary |
Addresses
Primary practice location
230 Chandler St
Duxbury, MA 02332-4233
Mailing address
230 Chandler St
Duxbury, MA 02332-4233
Phone (239) 823-9432
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160223002364 | MA | Practitioner - Clinical Social Worker | 4880999200 | Practice locations: Marshfield, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1996
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1928 Ocean St
1A
Marshfield, MA 02050-3323
Phone (781) 285-5866
230 Chandler St
Duxbury, MA 02332-4233
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119241 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569801600000",
"number": "1407221872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 CHANDLER ST",
"city": "DUXBURY",
"state": "MA",
"postal_code": "023324233",
"telephone_number": "239-823-9432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 CHANDLER ST",
"city": "DUXBURY",
"state": "MA",
"postal_code": "023324233",
"telephone_number": "508-830-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TACKITT",
"first_name": "MICHELLE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-10",
"last_updated": "2019-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "119241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.