Individual provider Active NPI

Jeneba Koroma

  • Clinical Social Worker
  • Beverly, MA
National Provider Identifier
1578178125
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LICSW128099 Issued in MA
Practice address
800 Cummings Ctr Ste 266T
Beverly, MA 01915-6172
Phone
(978) 998-2373
NPI assigned
Sep 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X LICSW128099 MA Primary

Addresses

Primary practice location

800 Cummings Ctr Ste 266T
Beverly, MA 01915-6172

Mailing address

800 Cummings Ctr Ste 266T
Beverly, MA 01915-6172
Phone (978) 998-2373

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

State licenses

LicenseStateTypeSpecialty
LICSW128099MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Health Services, LLC CurrentSince Jun 3, 2024 Accepting new patients

Locations

30 Taunton Grn
Ste 5
Taunton, MA 02780
Phone (508) 545-7400

50 Tower Office Park
Woburn, MA 01801
Phone (339) 345-2359

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1578178125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CUMMINGS CTR STE 266T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156172",
            "telephone_number": "978-998-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CUMMINGS CTR STE 266T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156172",
            "telephone_number": "978-998-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOROMA",
        "first_name": "JENEBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW128099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

Verify at the official NPI Registry.