Active NPI
Nicole M. Gagnon, LCSW
- Clinical Social Worker
- Boston, MA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW124767
- Practice address
- 1 Boston Medical Ctr PL
Boston, MA 02118-2908 - Phone
- (617) 414-5245
- Fax
- (617) 414-5520
- NPI assigned
- Jan 11, 2022
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LICSW124767 | MA | Primary |
Addresses
Primary practice location
1 Boston Medical Ctr PL
Boston, MA 02118-2908
Mailing address
960 Massachusetts Ave
FL 2
Boston, MA 02118-4308
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110187601A | Medicaid | MA |
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
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Internal Medical Associates-Ebnhc | Current | Accepting new patients |
Locations
10 Grove St
East Boston, MA 02128
Phone (617) 569-5800
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community Health Clinic/Center
- East Boston, MA
- NPI 1558481879
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Transitional Care Center and Stabilization Care Center
- General Acute Care Hospital
- Boston, MA
- NPI 1164177028
-
dba South Boston Community Health Center
- Community Health Clinic/Center
- South Boston, MA
- NPI 1225228679
Hospital
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
-
dba Greater Roslindale Medical and Dental Center
- Community Health Clinic/Center
- Roslindale, MA
- NPI 1386718823
Hospital
-
dba Dorchester House Multi Service Center
- Community Health Clinic/Center
- Dorchester, MA
- NPI 1780874677
Hospital
-
dba East Boston Neighborhood Health Center
- Community Health Clinic/Center
- East Boston, MA
- NPI 1861683518
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702857600000",
"number": "1780335810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "960 MASSACHUSETTS AVE",
"address_2": "FL 2",
"city": "BOSTON",
"state": "MA",
"postal_code": "021184308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOSTON MEDICAL CTR PL",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182908",
"telephone_number": "617-414-5245",
"fax_number": "617-414-5520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAGNON",
"first_name": "NICOLE",
"middle_name": "M.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-11",
"last_updated": "2023-12-18",
"certification_date": "2023-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LICSW124767",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110187601A",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.