Individual provider Active NPI

Suzanne Marguerite Costas, LICSW

  • Clinical Social Worker
  • Jamaica Plain, MA
National Provider Identifier
1881167955
Registry record updated Jan 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
222019 Issued in MA
Practice address
157 Green St
Jamaica Plain, MA 02130-2667
Phone
(617) 524-1120
NPI assigned
Jan 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2019

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 222019 MA Primary

Addresses

Primary practice location

157 Green St
Jamaica Plain, MA 02130-2667

Mailing address

64 Devonshire Rd
Waban, MA 02468-2213
Phone (617) 970-0503

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
I20200325003397 MA Practitioner - Clinical Social Worker 5890123871 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
222019MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Community Care, Inc. CurrentSince Feb 16, 2020 Accepting new patients

Locations

270 Bridge St
Ste 301
Dedham, MA 02026
Phone (617) 230-9905

190 Lenox St
Norwood, MA 02062
Phone (781) 769-8670

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": "1547078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1881167955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 DEVONSHIRE RD",
            "city": "WABAN",
            "state": "MA",
            "postal_code": "024682213",
            "telephone_number": "617-970-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 GREEN ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021302667",
            "telephone_number": "617-524-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTAS",
        "first_name": "SUZANNE",
        "middle_name": "MARGUERITE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "222019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica Plain, MA

Sources for this page

Verify at the official NPI Registry.