Kevin Stewart Reddall

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

265 Beach St
Revere, MA 02151-3131

Phone

(860) 303-9670

NPI assigned

Jun 5, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1871752824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 BEACH ST",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513131",
            "telephone_number": "860-303-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 BEACH ST",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513131",
            "telephone_number": "860-303-9670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDALL",
        "first_name": "KEVIN",
        "middle_name": "STEWART",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-05",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Misael Oliveira Rehbain
• Rettoc Optical Service
• Revere Adult Day Health Care
• Revere Dental and Orthodontics PC
• Revere Dentistry and Braces LLC

• Clinical Social Worker in Revere, MA
• Providers in Revere, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.