Individual provider Active NPI

Ann Marie Rossettie Fernandes, LICSW

  • Clinical Social Worker
  • Natick, MA
National Provider Identifier
1487715520
Registry record updated Feb 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
111058 Issued in MA
Practice address
317 N Main St
Natick, MA 01760-1115
Phone
(508) 872-1010
NPI assigned
Dec 13, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2022

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 111058 MA Primary

Addresses

Primary practice location

317 N Main St
Natick, MA 01760-1115

Mailing address

317 N Main St
Natick, MA 01760-1115
Phone (508) 872-1010

Other identifiers 4

IdentifierTypeStateIssuer
1303287MedicaidMA
M18633OtherMABCBC
703136OtherMATUFTS
042611055OtherMATAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644710400000",
    "number": "1487715520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 N MAIN ST",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017601115",
            "telephone_number": "508-872-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 N MAIN ST",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017601115",
            "telephone_number": "508-872-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDES",
        "first_name": "ANN",
        "middle_name": "MARIE ROSSETTIE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2022-02-13",
        "certification_date": "2022-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303287",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBC",
            "identifier": "M18633",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "703136",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "042611055",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Natick, MA

Sources for this page

Verify at the official NPI Registry.