Individual provider Active NPI

Andrea J Thompson, LICSW

  • Clinical Social Worker
  • Jamaica Plain, MA
National Provider Identifier
1780800573
Registry record updated Oct 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
113884 Issued in MA
Practice address
31 Heath St
Jamaica Plain, MA 02130-1650
Phone
(617) 523-6400
Fax
(617) 622-1086
NPI assigned
Apr 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2012

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 113884 MA Primary

Addresses

Primary practice location

31 Heath St
Jamaica Plain, MA 02130-1650

Mailing address

31 Heath St
Jamaica Plain, MA 02130-1650
Phone (617) 523-6400

Other identifiers 1

IdentifierTypeStateIssuer
1303414MedicaidMA

Other names 1

  • Mrs. Andrea J Thompson Other name

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

LicenseStateTypeSpecialty
113884MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family Service Association of Greater Boston Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351641600000",
    "number": "1780800573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 HEATH ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021301650",
            "telephone_number": "617-523-6400",
            "fax_number": "617-622-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 HEATH ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021301650",
            "telephone_number": "617-523-6400",
            "fax_number": "617-622-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "ANDREA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2012-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303414",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "THOMPSON",
            "middle_name": "J",
            "prefix": "MRS.",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jamaica Plain, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.