Individual provider Active NPI

Joshua Yong-Soo Smith, LICSW

  • Clinical Social Worker
  • Somerville, MA
National Provider Identifier
1518442920
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
120499 Issued in MA
Practice address
153 South St
Somerville, MA 02143-4297
Phone
(617) 863-5400
NPI assigned
Oct 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

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 120499 MA Primary

Addresses

Primary practice location

153 South St
Somerville, MA 02143-4297

Mailing address

153 South St
Somerville, MA 02143-4297

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
I20240903000101 MA Practitioner - Clinical Social Worker 4183163363

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
120499MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Vinfen Corporation CurrentSince Jun 27, 2024 Accepting new patients

Locations

950 Cambridge St
Cambridge, MA 02141
Phone (617) 441-1743

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1518442920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 SOUTH ST",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021434297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 SOUTH ST",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021434297",
            "telephone_number": "617-863-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOSHUA",
        "middle_name": "YONG-SOO",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "120499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

Verify at the official NPI Registry.