Active NPI
Tina Sheridan, MSW, LICSW
- Social Worker
- Marlborough, MA
National Provider Identifier
1447617857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 413979
- Practice address
- 110 Fontaine St
Marlborough, MA 01752-6501 - Phone
- (617) 599-5331
- NPI assigned
- Jan 15, 2016
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 413979 | MA | Primary |
Addresses
Primary practice location
110 Fontaine St
Marlborough, MA 01752-6501
Mailing address
110 Fontaine St
Marlborough, MA 01752-6501
Phone (617) 599-5331
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 |
|---|---|---|---|
| 413979 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586822400000",
"number": "1447617857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 FONTAINE ST",
"city": "MARLBOROUGH",
"state": "MA",
"postal_code": "017526501",
"telephone_number": "617-599-5331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 FONTAINE ST",
"city": "MARLBOROUGH",
"state": "MA",
"postal_code": "017526501",
"telephone_number": "617-599-5331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHERIDAN",
"first_name": "TINA",
"name_prefix": "Mrs.",
"credential": "MSW, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-15",
"last_updated": "2020-04-14",
"certification_date": "2020-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "413979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marlborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.