Active NPI
Eileen Kern, LICSW
- Clinical Social Worker
- Lexington, MA
National Provider Identifier
1801018734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 105892
- Practice address
- 789 Massachusetts Ave
Lexington, MA 02420-3915 - Phone
- (857) 245-5339
- NPI assigned
- May 2, 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 | 105892 | MA | Primary |
Addresses
Primary practice location
789 Massachusetts Ave
Lexington, MA 02420-3915
Mailing address
789 Massachusetts Ave
Lexington, MA 02420-3915
Phone (857) 245-5339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PO4372 | Other | MA | BLUE CROSS PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 14, 2023 through Nov 14, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105892 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593993600000",
"number": "1801018734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "789 MASSACHUSETTS AVE",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024203915",
"telephone_number": "857-245-5339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "789 MASSACHUSETTS AVE",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024203915",
"telephone_number": "857-245-5339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERN",
"first_name": "EILEEN",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2020-07-06",
"certification_date": "2020-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "105892",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER #",
"identifier": "PO4372",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.