Active NPI
Michele Dervartanian, LICSW
- Clinical Social Worker
- Waltham, MA
National Provider Identifier
1871895789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 116564
- Practice address
- 118 Central Street
Waltham, MA 02453 - Phone
- (781) 891-0556
- NPI assigned
- Nov 29, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | 216010 | MA | |
| Clinical Social Worker | 1041C0700X | 116564 | MA | Primary |
Addresses
Primary practice location
118 Central Street
Waltham, MA 02453
Mailing address
119 Medford St
Arlington, MA 02474-3117
Phone (781) 799-0951
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116564 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397692800000",
"number": "1871895789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 MEDFORD ST",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024743117",
"telephone_number": "781-799-0951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 CENTRAL STREET",
"city": "WALTHAM",
"state": "MA",
"postal_code": "02453",
"telephone_number": "781-891-0556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERVARTANIAN",
"first_name": "MICHELE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-29",
"last_updated": "2014-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "216010",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "116564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.