Active NPI
Bonnie Nessanbaum, LICSW
- Clinical Social Worker
- Tewksbury, MA
National Provider Identifier
1669452462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1016620
- Practice address
- 1565 Main St
BLD.2 Room 206
Tewksbury, MA 01876-2085 - Phone
- (617) 628-3555
- Fax
- (617) 288-3910
- NPI assigned
- Jan 18, 2006
- Last updated
- Dec 3, 2009
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1016620 | MA | Primary |
Addresses
Primary practice location
1565 Main St
BLD.2 Room 206
Tewksbury, MA 01876-2085
Mailing address
38 Pickney St
Somerville, MA 02145
Phone (617) 628-3555
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1016620 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259798400000",
"number": "1669452462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 PICKNEY ST",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "02145",
"telephone_number": "617-628-3555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1565 MAIN ST",
"address_2": "BLD.2 ROOM 206",
"city": "TEWKSBURY",
"state": "MA",
"postal_code": "018762085",
"telephone_number": "617-628-3555",
"fax_number": "617-288-3910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NESSANBAUM",
"first_name": "BONNIE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-18",
"last_updated": "2009-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1016620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tewksbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.