Individual provider Active NPI

Christine Cannon, LICSW

  • Clinical Social Worker
  • Boston, MA
National Provider Identifier
1750602785
Registry record updated Sep 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
115663 Issued in MA
Practice address
30 Northampton St
Boston, MA 02118-4010
Phone
(617) 433-9601
Fax
(617) 445-6538
NPI assigned
Jun 14, 2010
Last updated
Sep 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2025

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 115663 MA Primary

Addresses

Primary practice location

30 Northampton St
Boston, MA 02118-4010

Mailing address

30 Northampton St
Boston, MA 02118-4098
Phone (617) 433-9601

Other practice location 1

11 River St
Wellesley, MA 02481-2017
Phone (781) 431-1177 ext. 11177

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
I20120525000384 MA Practitioner - Clinical Social Worker 8022271295 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians
Colony Care IncGroup PAC ID 0042282055, 29 clinicians

Practice addresses (Care Compare)

101 Federal St
Boston, MA 02110-1817
Phone (323) 205-7088

11 River St
Wellesley, MA 02481-2098
Phone (781) 431-1177

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Vita G Counseling LLC CurrentSince Jan 16, 2025 Accepting new patients
Northeast Health Services, LLC CurrentSince Jun 1, 2025 Accepting new patients
Colony Care Inc CurrentSince Sep 5, 2025 Accepting new patients
Mental Health Specialty Group PA CurrentSince Jun 1, 2025 Accepting new patients
Center for Integrative Counseling and Wellness LLC CurrentSince Jul 17, 2024 Accepting new patients

Locations

101 Federal St
Boston, MA 02110
Phone (206) 744-8030

231 Main St
Fl 3
Brockton, MA 02301
Phone (508) 586-2660

62 Derby St
Ste 6
Hingham, MA 02043
Phone (781) 254-8915

30 Taunton Grn
Ste 5
Taunton, MA 02780
Phone (508) 545-7400

11 River St
Wellesley Hills, MA 02481
Phone (781) 237-7979

11 River St
Ste 1
Wellesley Hls, MA 02481
Phone (508) 695-7447

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757030400000",
    "number": "1750602785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 NORTHAMPTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184098",
            "telephone_number": "617-433-9601",
            "fax_number": "617-445-6538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 NORTHAMPTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184010",
            "telephone_number": "617-433-9601",
            "fax_number": "617-445-6538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 River St",
            "address_purpose": "LOCATION",
            "city": "Wellesley",
            "state": "MA",
            "postal_code": "024812017",
            "country_code": "US",
            "telephone_number": "781-431-1177 x11177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-14",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "115663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.