Active NPI
Julia Kidd, LICSW
- Social Worker
- Tisbury, MA
National Provider Identifier
1578614285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 110579
- Practice address
- 9597 State Rd
Suite 301
Tisbury, MA 02568 - Phone
- (508) 696-5966
- NPI assigned
- Jan 16, 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 110579 | MA | Primary |
Addresses
Primary practice location
9597 State Rd
Suite 301
Tisbury, MA 02568
Mailing address
PO Box 4673
Vineyard Haven, MA 02568
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P07757 | Other | MA | BLUE CROSS |
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: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Aug 19, 2019 through Aug 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110579 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578614285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4673",
"city": "VINEYARD HAVEN",
"state": "MA",
"postal_code": "02568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9597 STATE RD",
"address_2": "SUITE 301",
"city": "TISBURY",
"state": "MA",
"postal_code": "02568",
"telephone_number": "508-696-5966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDD",
"first_name": "JULIA",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "110579",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "P07757",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tisbury, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.