Individual provider Active NPI

Dawn Martin, LICSW

  • Clinical Social Worker
  • Mansfield, MA
National Provider Identifier
1750868402
Registry record updated Jul 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
111667 Issued in MA
Practice address
240 East St
Mansfield, MA 02048-2526
Phone
(508) 261-7530
NPI assigned
Jul 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
School Counselor 101YS0200X MA
Clinical Social Worker 1041C0700X 111667 MA Primary

Addresses

Primary practice location

240 East St
Mansfield, MA 02048-2526

Mailing address

10 Lantern LN
Wrentham, MA 02093-1740
Phone (508) 369-7622

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

LicenseStateTypeSpecialty
111667MAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1750868402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 LANTERN LN",
            "city": "WRENTHAM",
            "state": "MA",
            "postal_code": "020931740",
            "telephone_number": "508-369-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 EAST ST",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020482526",
            "telephone_number": "508-261-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DAWN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.