Active NPI
Elisabeth Van Der Kolk, L.I.C.S.W.
- Clinical Social Worker
- Watertown, MA
National Provider Identifier
1487773404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 102645
- Practice address
- 23 Main St
Watertown, MA 02472-4403 - Phone
- (617) 312-4116
- NPI assigned
- Mar 29, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 102645 | MA | Primary |
Addresses
Primary practice location
23 Main St
Watertown, MA 02472-4403
Mailing address
156 Green Street #301
Jamaica Plain, MA 02130
Phone (617) 312-4116
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 459408 | Other | MA | TUFTS HEALTH PLAN |
| VAP03254 | Other | MA | BLUE CROSS BLUE SHIELD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1487773404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 GREEN STREET #301",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "02130",
"telephone_number": "617-312-4116",
"fax_number": "617-942-2041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 MAIN ST",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024724403",
"telephone_number": "617-312-4116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DER KOLK",
"first_name": "ELISABETH",
"name_prefix": "Ms.",
"credential": "L.I.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "102645",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "459408",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "VAP03254",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watertown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.