Active NPI
Allen Mark Spivack, LICSW
- Clinical Social Worker
- Roxbury, MA
National Provider Identifier
1417240706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1029802
- Practice address
- 55 Dimock St
Room 309
Roxbury, MA 02119-1029 - Phone
- (617) 442-8800
- Fax
- (617) 427-1126
- NPI assigned
- May 19, 2011
- Sex
- Male
- 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 | 1029802 | MA | Primary |
Addresses
Primary practice location
55 Dimock St
Room 309
Roxbury, MA 02119-1029
Mailing address
55 Dimock St
Room 309
Roxbury, MA 02119-1029
Phone (617) 442-8800
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1029802 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305763200000",
"number": "1417240706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 DIMOCK ST",
"address_2": "ROOM 309",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021191029",
"telephone_number": "617-442-8800",
"fax_number": "617-427-1126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 DIMOCK ST",
"address_2": "ROOM 309",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021191029",
"telephone_number": "617-442-8800",
"fax_number": "617-427-1126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPIVACK",
"first_name": "ALLEN",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-19",
"last_updated": "2011-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1029802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.