Theresa Blackman
Individual provider Active NPI Clinical Social Worker · Medford, MA
NPI 1669921482 · NPPES record last updated Sep 22, 2016
Key facts
- NPI
- 1669921482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Practice address
- 22 Valley St
Medford, MA 02155-2521 - Phone
- (617) 935-3147
- NPI assigned
- Sep 22, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fenway Community Health Center, Inc
Practice addresses (Care Compare)
1340 Boylston St
Boston, MA 02215-4302
Phone (617) 267-0900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240904004181 | MA | Practitioner - Clinical Social Worker | 4082154158 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fenway Community Health Center, Inc | Current |
Accepting new patients | |
| Fenway Community Health Center, Inc | Current |
Accepting new patients |
Locations
1340 Boylston St
Boston, MA 02215
Phone (617) 267-0900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Yes |
Addresses
Primary practice location
22 Valley St
Medford, MA 02155-2521
Mailing address
22 Valley St
Medford, MA 02155-2521
Other providers in Medford, MA
- Stephanie Lee Bivona
- Rachel Dawn Biwer
- BJ'S Wholesale Club Inc.
- Stephanie S Bjork
- Rhonda Lee Black
- Blake Acupuncture & Herbal Medicine
- Lisa Blake
- Eugenia Blank
- Joel G Bleier
- Elaine J Block-Pellegrini
All providers in Medford, MA · Clinical Social Worker in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.