Active NPI
Noreen Kavanaugh, LICSW
- Clinical Social Worker
- Needham, MA
National Provider Identifier
1720018443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 104915
- Practice address
- 1040 Great Plain Ave
Needham, MA 02492-2565 - Phone
- (781) 449-5123
- NPI assigned
- Jul 5, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 104915 | MA | Primary |
Addresses
Primary practice location
1040 Great Plain Ave
Needham, MA 02492-2565
Mailing address
18 Edgewood St
Needham, MA 02492-3612
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104915 | Other | MA | LICENSE |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070328000143 | MA | Practitioner - Clinical Social Worker | 0840394045 | Practice locations: Needham, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1206 Greendale Ave
Apt 230
Needham, MA 02492-4618
Phone (781) 449-1913
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104915 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720018443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 EDGEWOOD ST",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024923612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 GREAT PLAIN AVE",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024922565",
"telephone_number": "781-449-5123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAVANAUGH",
"first_name": "NOREEN",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "104915",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "104915",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Needham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.