Individual provider Active NPI

Matthew Steven Bronheim, LCSW

  • Counselor
  • Boston, MA
National Provider Identifier
1457839276
Registry record updated Jul 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
66 Canal St
Boston, MA 02114-2002
Phone
(617) 619-5939
Fax
(617) 371-3038
NPI assigned
Aug 2, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

66 Canal St
Boston, MA 02114-2002

Mailing address

66 Canal St
Boston, MA 02114-2002
Phone (617) 619-5939

Other practice location 1

14 Fordham Rd
Allston, MA 02134-3006
Phone (617) 782-6460

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)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1457839276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 CANAL ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142002",
            "telephone_number": "617-619-5939",
            "fax_number": "617-371-3038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 CANAL ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142002",
            "telephone_number": "617-619-5939",
            "fax_number": "617-371-3038"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Fordham Rd",
            "address_purpose": "LOCATION",
            "city": "Allston",
            "state": "MA",
            "postal_code": "021343006",
            "country_code": "US",
            "telephone_number": "617-782-6460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRONHEIM",
        "first_name": "MATTHEW",
        "middle_name": "STEVEN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-02",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jul 16, 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.

Verify at the official NPI Registry.