Active NPI
Michelle Bothmann, LICSW
- Clinical Social Worker
- Boston, MA
National Provider Identifier
1801321658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 121630
- Practice address
- 133 Brookline Ave
Boston, MA 02215-3904 - Phone
- (617) 421-1157
- NPI assigned
- Apr 28, 2017
- Last updated
- Aug 6, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 222122 | MA | |
| Clinical Social Worker | 1041C0700X | 121630 | MA | Primary |
Addresses
Primary practice location
133 Brookline Ave
Boston, MA 02215-3904
Mailing address
133 Brookline Ave
Boston, MA 02215-3904
Phone (617) 421-1157
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 6, 2025 through Mar 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121630 | MA | MD | Clinical Social Worker |
| 222122 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628208000000",
"number": "1801321658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 BROOKLINE AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022153904",
"telephone_number": "617-421-1157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 BROOKLINE AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022153904",
"telephone_number": "617-421-1157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTHMANN",
"first_name": "MICHELLE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-28",
"last_updated": "2021-08-06",
"certification_date": "2021-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "222122",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "121630",
"primary": true
}
],
"identifiers": [],
"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 Aug 6, 2021; 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.