Individual provider Active NPI

Annette M Berson-Smith, LICSW

  • Clinical Social Worker
  • Beverly, MA
National Provider Identifier
1639190283
Registry record updated Jun 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
114601 Issued in MA
Practice address
800 Cummings Ctr
Suite 266T
Beverly, MA 01915-6175
Phone
(978) 921-1190
NPI assigned
Jul 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2009

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 114601 MA Primary

Addresses

Primary practice location

800 Cummings Ctr
Suite 266T
Beverly, MA 01915-6175

Mailing address

9 Pamela LN
Amesbury, MA 01913-1007
Phone (617) 413-0376

Other identifiers 1

IdentifierTypeStateIssuer
000903401OtherMAMEDICARE

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
I20090112000175 MA Practitioner - Clinical Social Worker 0840353215 Practice locations: Amesbury, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

14 Cedar St
Suite 202
Amesbury, MA 01913-1831
Phone (978) 473-0820

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
114601MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Behavioral Health Corporation PastSince May 8, 2017 Accepting new patients

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244505600000",
    "number": "1639190283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 PAMELA LN",
            "city": "AMESBURY",
            "state": "MA",
            "postal_code": "019131007",
            "telephone_number": "617-413-0376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CUMMINGS CTR",
            "address_2": "SUITE 266T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156175",
            "telephone_number": "978-921-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERSON-SMITH",
        "first_name": "ANNETTE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2009-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "114601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000903401",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

Verify at the official NPI Registry.