Active NPI
Jerrold Breshin, LICSW
- Clinical Social Worker
- Falmouth, MA
National Provider Identifier
1518985407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW107504
- Practice address
- 342 Gifford St Unit C
Falmouth, MA 02540-5107 - Phone
- (508) 495-0554
- Fax
- (508) 495-0559
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW107504 | MA | Primary |
| Clinical Social Worker | 1041C0700X | PR041299-1 | NY |
Addresses
Primary practice location
342 Gifford St Unit C
Falmouth, MA 02540-5107
Mailing address
11 Teneycke Hill Rd
N Falmouth, MA 02556-3118
Phone (508) 495-0554
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1038700 | Other | MA | TRICARE |
| 1896024 | Other | MA | MBHP |
| 1896024 | Medicaid | MA | |
| 1854941 | Other | MA | MASS HEALTH |
| 2041870 | Other | MA | HCVM |
| P07062 | Other | MA | BCBSMA |
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 |
|---|---|---|---|
| SW107504 | MA | MD | Clinical Social Worker |
| PR041299-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1518985407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 TENEYCKE HILL RD",
"city": "N FALMOUTH",
"state": "MA",
"postal_code": "025563118",
"telephone_number": "508-495-0554",
"fax_number": "508-495-0559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "342 GIFFORD ST UNIT C",
"city": "FALMOUTH",
"state": "MA",
"postal_code": "025405107",
"telephone_number": "508-495-0554",
"fax_number": "508-495-0559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRESHIN",
"first_name": "JERROLD",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "SW107504",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "PR041299-1",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "1038700",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MBHP",
"identifier": "1896024",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1896024",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASS HEALTH",
"identifier": "1854941",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HCVM",
"identifier": "2041870",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSMA",
"identifier": "P07062",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Falmouth, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.