Active NPI
Kurt David Nelson, LICSW
- Clinical Social Worker
- Somerville, MA
National Provider Identifier
1720215858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW115063
- Practice address
- 1234 Broadway
Somerville, MA 02144-1703 - Phone
- (617) 840-8906
- NPI assigned
- Jun 16, 2009
- Sex
- Male
- 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 | LICSW115063 | MA | Primary |
Addresses
Primary practice location
1234 Broadway
Somerville, MA 02144-1703
Mailing address
1234 Broadway
Somerville, MA 02144-1703
Phone (617) 840-8906
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 |
|---|---|---|---|
| LICSW115063 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741651200000",
"number": "1720215858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1234 BROADWAY",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021441703",
"telephone_number": "617-840-8906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1234 BROADWAY",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021441703",
"telephone_number": "617-840-8906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "KURT",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-16",
"last_updated": "2025-03-11",
"certification_date": "2025-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LICSW115063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerville, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.