Individual provider Active NPI

Alexandra L. Myles, LICSW #100605

  • Clinical Social Worker
  • Cambridge, MA
National Provider Identifier
1619069952
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
100605 Issued in MA
Practice address
250 Brattle St
Unit #22
Cambridge, MA 02138-4631
Phone
(617) 497-0190
Fax
(617) 497-0190
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 100605 MA Primary

Addresses

Primary practice location

250 Brattle St
Unit #22
Cambridge, MA 02138-4631

Mailing address

250 Brattle St
Unit #22
Cambridge, MA 02138-4631
Phone (617) 497-0190

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

LicenseStateTypeSpecialty
100605MAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619069952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 BRATTLE ST",
            "address_2": "UNIT #22",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021384631",
            "telephone_number": "617-497-0190",
            "fax_number": "617-497-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BRATTLE ST",
            "address_2": "UNIT #22",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021384631",
            "telephone_number": "617-497-0190",
            "fax_number": "617-497-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYLES",
        "first_name": "ALEXANDRA",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "LICSW #100605",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "100605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, 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.

Verify at the official NPI Registry.