Active NPI
Maureen Dervan
- Social Worker
- Canton, MA
National Provider Identifier
1659900769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 115587
- Practice address
- 7 Shepard Way
Canton, MA 02021-1119 - Phone
- (917) 902-1476
- NPI assigned
- Apr 2, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 115587 | MA | Primary |
Addresses
Primary practice location
7 Shepard Way
Canton, MA 02021-1119
Mailing address
7 Shepard Way
Canton, MA 02021-1119
Phone (917) 902-1476
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | maureendervan@gmail.com | Direct |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115587 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585785600000",
"number": "1659900769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 SHEPARD WAY",
"city": "CANTON",
"state": "MA",
"postal_code": "020211119",
"telephone_number": "917-902-1476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 SHEPARD WAY",
"city": "CANTON",
"state": "MA",
"postal_code": "020211119",
"telephone_number": "917-902-1476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERVAN",
"first_name": "MAUREEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-02",
"last_updated": "2020-04-02",
"certification_date": "2020-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "115587",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "maureendervan@gmail.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Canton",
"address_1": "7 Shepard Way",
"city": "Canton",
"state": "MA",
"country_code": "US",
"postal_code": "020211119",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Canton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.