Individual provider Active NPI

Amanda Marie Parent

  • Developmental Therapist
  • Milford, MA
National Provider Identifier
1790158640
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental TherapistTaxonomy code 222Q00000X
Practice address
321 Fortune Blvd
Milford, MA 01757-1750
Phone
(508) 478-0207
Fax
(508) 634-6984
NPI assigned
Nov 1, 2015
Reactivated
Jul 10, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X Primary

Addresses

Primary practice location

321 Fortune Blvd
Milford, MA 01757-1750

Mailing address

321 Fortune Blvd
Milford, MA 01757-1750
Phone (508) 478-0207

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
I20230715000291 MA Practitioner - Clinical Social Worker 1456711951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SB Transitional Sub LLCGroup PAC ID 7911315379, 70 clinicians

Practice addresses (Care Compare)

37 Water St
Suite 1
Wakefield, MA 01880-3044
Phone (508) 521-2200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
SB Transitional Sub, LLC CurrentSince May 29, 2023 Accepting new patients
South Bay Mental Health Center, Inc. CurrentSince May 29, 2023 Accepting new patients

Locations

103 Commercial St
Ste 2
Brockton, MA 02302

37 Water St
Ste 1
Wakefield, MA 01880
Phone (781) 223-8042

Organizations & group practices 2

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": "1446336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1790158640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 FORTUNE BLVD",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017571750",
            "telephone_number": "508-478-0207",
            "fax_number": "508-634-6984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 FORTUNE BLVD",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017571750",
            "telephone_number": "508-478-0207",
            "fax_number": "508-634-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARENT",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-01",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "deactivation_date": "2023-05-31",
        "reactivation_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, MA

Sources for this page

Verify at the official NPI Registry.