Individual provider Active NPI

Deborah Max Reisman, LICSW

  • Clinical Social Worker
  • Medford, MA
National Provider Identifier
1841397825
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
106645 Issued in MA
Practice address
151 Mystic Ave
Suite Six
Medford, MA 02155-4632
Phone
(781) 396-1199
Fax
(781) 396-1439
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 106645 MA Primary

Addresses

Primary practice location

151 Mystic Ave
Suite Six
Medford, MA 02155-4632

Mailing address

75 Beethoven Ave
Waban, MA 02468-1732
Phone (617) 332-3980

Other identifiers 1

IdentifierTypeStateIssuer
P04193OtherMABCBS

Other names 1

  • Deborah Reisman Other name

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
I20050916000412 MA Practitioner - Clinical Social Worker 6002849395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DCS Mental Health, IncGroup PAC ID 8820992456, 20 clinicians

Practice addresses (Care Compare)

151 Mystic Ave
Suite 6
Medford, MA 02155-4632
Phone (781) 396-1199

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
106645MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
DCS Mental Health, Inc CurrentSince May 9, 2001 Accepting new patients

Locations

151 Mystic Ave
Ste 6
Medford, MA 02155
Phone (617) 396-1199

Organizations & group practices 1

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322438400000",
    "number": "1841397825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 BEETHOVEN AVE",
            "city": "WABAN",
            "state": "MA",
            "postal_code": "024681732",
            "telephone_number": "617-332-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 MYSTIC AVE",
            "address_2": "SUITE SIX",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554632",
            "telephone_number": "781-396-1199",
            "fax_number": "781-396-1439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISMAN",
        "first_name": "DEBORAH",
        "middle_name": "MAX",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "106645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "P04193",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBORAH",
            "last_name": "REISMAN",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Medford, MA

Sources for this page

Verify at the official NPI Registry.