Individual provider Active NPI

Beth A. Mullek, LICSW

  • Clinical Social Worker
  • West Springfield, MA
National Provider Identifier
1871865634
Registry record updated Feb 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
111116 Issued in MA
Practice address
103 Myron St
Suite a
West Springfield, MA 01089-1598
Phone
(413) 592-1980
Fax
(413) 439-0100
NPI assigned
Feb 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2012

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 111116 MA Primary

Addresses

Primary practice location

103 Myron St
Suite a
West Springfield, MA 01089-1598

Mailing address

46 Pawtucket Blvd
#33
Tyngsboro, MA 01879-1584

Other names 1

  • Beth A. Petro-Roy Former 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
I20120501000124 MA Practitioner - Clinical Social Worker 7810159274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

929 Mass Ave
Suite 103
Cambridge, MA 02139-3134
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Nov 4, 2020 Accepting new patients

Locations

872 Massachusetts Ave
Ste 2-2
Cambridge, MA 02139
Phone 6173804651 ext. 1992

929 Massachusetts Ave
Ste 103
Cambridge, MA 02139
Phone (617) 395-5806

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

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": "1328659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328659200000",
    "number": "1871865634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 PAWTUCKET BLVD",
            "address_2": "#33",
            "city": "TYNGSBORO",
            "state": "MA",
            "postal_code": "018791584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MYRON ST",
            "address_2": "SUITE A",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010891598",
            "telephone_number": "413-592-1980",
            "fax_number": "413-439-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEK",
        "first_name": "BETH",
        "middle_name": "A.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-08",
        "last_updated": "2012-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETH",
            "last_name": "PETRO-ROY",
            "middle_name": "A.",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Springfield, MA

Sources for this page

Verify at the official NPI Registry.