Individual provider Active NPI

Gerard Dennis Miller, MSW, LICSW, CEAP

  • Clinical Social Worker
  • Boston, MA
National Provider Identifier
1447327523
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
104784 Issued in MA
Practice address
129 Warren Ave
Boston, MA 02116-5982
Phone
(617) 236-1407
NPI assigned
Nov 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 104784 MA Primary

Addresses

Primary practice location

129 Warren Ave
Boston, MA 02116-5982

Mailing address

129 Warren Ave
Boston, MA 02116-5982
Phone (617) 236-1407

Other identifiers 1

IdentifierTypeStateIssuer
104784OtherMALICSW LICENSE NUMBER

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130218000137 MA Practitioner - Clinical Social Worker 9537313796 Practice locations: Boston, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

129 Warren Ave
Boston, MA 02116-5982

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104784MAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447327523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 WARREN AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165982",
            "telephone_number": "617-236-1407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 WARREN AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165982",
            "telephone_number": "617-236-1407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "GERARD",
        "middle_name": "DENNIS",
        "name_prefix": "Mr.",
        "credential": "MSW, LICSW, CEAP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "104784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICSW LICENSE NUMBER",
            "identifier": "104784",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.