Active NPI
Bethany Elaine Kullman-Duval, LICSW
- Clinical Social Worker
- Winchendon, MA
National Provider Identifier
1831202142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1031066
- Practice address
- 55 Hospital Dr
Winchendon, MA 01475-1820 - Phone
- (603) 680-1654
- Fax
- (978) 630-6845
- NPI assigned
- Aug 17, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1031066 | MA | Primary |
Addresses
Primary practice location
55 Hospital Dr
Winchendon, MA 01475-1820
Mailing address
43 Spindleback LN
New Ipswich, NH 03071-3230
Phone (603) 680-1654
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151117000847 | MA | Practitioner - Clinical Social Worker | 7911217252 | Practice locations: Winchendon, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1995
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
55 Hospital Dr
Winchendon, MA 01475-1820
Phone (603) 680-1654
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1031066 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445212800000",
"number": "1831202142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 SPINDLEBACK LN",
"city": "NEW IPSWICH",
"state": "NH",
"postal_code": "030713230",
"telephone_number": "603-680-1654",
"fax_number": "978-630-6845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 HOSPITAL DR",
"city": "WINCHENDON",
"state": "MA",
"postal_code": "014751820",
"telephone_number": "603-680-1654",
"fax_number": "978-630-6845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULLMAN-DUVAL",
"first_name": "BETHANY",
"middle_name": "ELAINE",
"name_prefix": "Mrs.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-17",
"last_updated": "2015-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1031066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winchendon, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.