Active NPI
Mandi Ella Clegg, BSW, MSW
- Social Worker
- Brockton, MA
National Provider Identifier
1760009328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 122817
- Practice address
- 680 Centre St
Brockton, MA 02302-3308 - Phone
- (508) 941-7498
- NPI assigned
- Jun 30, 2020
- Last updated
- Jun 30, 2020
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 122817 | MA | Primary |
Addresses
Primary practice location
680 Centre St
Brockton, MA 02302-3308
Mailing address
99 Depot St Unit B
South Easton, MA 02375-1162
Phone (518) 526-0405
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122817 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593475200000",
"number": "1760009328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 DEPOT ST UNIT B",
"city": "SOUTH EASTON",
"state": "MA",
"postal_code": "023751162",
"telephone_number": "518-526-0405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 CENTRE ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023308",
"telephone_number": "508-941-7498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEGG",
"first_name": "MANDI",
"middle_name": "ELLA",
"credential": "BSW, MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-30",
"last_updated": "2020-06-30",
"certification_date": "2020-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "122817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.