Individual provider Active NPI

Jonathan Michael Rosen, LICSW

  • Clinical Social Worker
  • Southbridge, MA
National Provider Identifier
1629366844
Registry record updated Dec 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
118720 Issued in MA
Practice address
100 South St
Southbridge, MA 01550-4051
Phone
(508) 764-5075
NPI assigned
Jul 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2015

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 118720 MA Primary

Addresses

Primary practice location

100 South St
Southbridge, MA 01550-4051

Mailing address

100 South St
Southbridge, MA 01550-4051
Phone (508) 764-5075

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
I20160707001508 MA Practitioner - Clinical Social Worker 6709178056 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
118720MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group, Inc. CurrentSince Oct 3, 2023 Accepting new patients
Umass Memorial Medical Group Inc CurrentSince Oct 3, 2023 Accepting new patients

Locations

100 South St
Southbridge, MA 01550
Phone (508) 764-8012

29 Pine St
Southbridge, MA 01550
Phone (508) 765-2202

340 Thompson Rd
Webster, MA 01570
Phone (508) 943-2600

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Organizations & group practices 2

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": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450310400000",
    "number": "1629366844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SOUTH ST",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015504051",
            "telephone_number": "508-764-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SOUTH ST",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015504051",
            "telephone_number": "508-764-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSEN",
        "first_name": "JONATHAN",
        "middle_name": "MICHAEL",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-21",
        "last_updated": "2015-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "118720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbridge, MA

Sources for this page

Verify at the official NPI Registry.