Active NPI
Mark Stephen Spivak, LICSW
- Clinical Social Worker
- Newburyport, MA
National Provider Identifier
1750509352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 105249
- Practice address
- 25 State St
Newburyport, MA 01950-6614 - Phone
- (978) 948-5505
- Fax
- (978) 948-5505
- NPI assigned
- Apr 22, 2007
- 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 | 105249 | MA | Primary |
Addresses
Primary practice location
25 State St
Newburyport, MA 01950-6614
Mailing address
38 Fenno Dr
Rowley, MA 01969-1005
Phone (978) 948-5505
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 |
|---|---|---|---|---|
| I20050928000850 | MA | Practitioner - Clinical Social Worker | 0749215721 | Practice locations: Danvers, MA; Newburyport, MA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105249 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1750509352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 FENNO DR",
"city": "ROWLEY",
"state": "MA",
"postal_code": "019691005",
"telephone_number": "978-948-5505",
"fax_number": "978-948-5505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 STATE ST",
"city": "NEWBURYPORT",
"state": "MA",
"postal_code": "019506614",
"telephone_number": "978-948-5505",
"fax_number": "978-948-5505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPIVAK",
"first_name": "MARK",
"middle_name": "STEPHEN",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-22",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "105249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newburyport, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.