Active NPI
Nina Ann Avedon, LICSW
- Clinical Social Worker
- Brookline, MA
National Provider Identifier
1790840452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 102795
- Practice address
- 1101 Beacon St Ste 7
Brookline, MA 02446-5587 - Phone
- (617) 734-6589
- NPI assigned
- Dec 23, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 102795 | MA | Primary |
Addresses
Primary practice location
1101 Beacon St Ste 7
Brookline, MA 02446-5587
Mailing address
60 Longwood Ave Apt 607
Brookline, MA 02446-5287
Phone (617) 232-8934
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PO3392 | Other | MA | BLUE CROSS PROVIDER NUMBE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 3, 2022 through May 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102795 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790840452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 LONGWOOD AVE APT 607",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024465287",
"telephone_number": "617-232-8934",
"fax_number": "617-232-5531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 BEACON ST STE 7",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024465587",
"telephone_number": "617-734-6589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVEDON",
"first_name": "NINA",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "102795",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER NUMBE",
"identifier": "PO3392",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.