Individual provider Active NPI

Daria J. Medwid, LICSW

  • Clinical Social Worker
  • Newton, MA
National Provider Identifier
1720005739
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1023460 Issued in MA
Practice address
38 Colonial Ave
Newton, MA 02460-1215
Phone
(617) 964-4575
NPI assigned
Jul 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 1023460 MA Primary

Addresses

Primary practice location

38 Colonial Ave
Newton, MA 02460-1215

Mailing address

39 Stanley Ave
Medford, MA 02155-5617
Phone (781) 395-1281

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
I20120227000035 MA Practitioner - Clinical Social Worker 4183882806 Practice locations: Newton, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Boston University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

38 Colonial Ave
Newton, MA 02460-1215
Phone (617) 964-4575

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Suzanne C. Kearney Licsw, Inc. Clinical PastSince Nov 24, 2019 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": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720005739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 STANLEY AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021555617",
            "telephone_number": "781-395-1281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 COLONIAL AVE",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024601215",
            "telephone_number": "617-964-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDWID",
        "first_name": "DARIA",
        "middle_name": "J.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1023460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, MA

Sources for this page

Verify at the official NPI Registry.