Active NPI
Deanna Pedro Pham
- Clinical Social Worker
- Worcester, MA
National Provider Identifier
1881795508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1021584
- Practice address
- 55 Lake Ave N
Ummmc, Department of Psychiatry
Worcester, MA 01655-0002 - Phone
- (508) 334-3240
- Fax
- (508) 421-1000
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1021584 | MA | Primary |
Addresses
Primary practice location
55 Lake Ave N
Ummmc, Department of Psychiatry
Worcester, MA 01655-0002
Mailing address
PO Box 415348
Boston, MA 02241-5348
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dpedropham27938@UmassMemorial.direct-ci.com | ||
| FHIR URL | https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ |
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 |
|---|---|---|---|
| 1021584 | MA | MD | Clinical Social Worker |
Interoperability endpoints
- dpedropham27938@umassmemorial.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1881795508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 415348",
"city": "BOSTON",
"state": "MA",
"postal_code": "022415348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAKE AVE N",
"address_2": "UMMMC, DEPARTMENT OF PSYCHIATRY",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016550002",
"telephone_number": "508-334-3240",
"fax_number": "508-421-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "DEANNA",
"middle_name": "PEDRO",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1021584",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dpedropham27938@UmassMemorial.direct-ci.com",
"affiliation": "N",
"address_1": "55 Lake Ave N",
"address_2": "UMMMC, Department of Psychiatry",
"city": "Worcester",
"state": "MA",
"country_code": "US",
"postal_code": "016550002",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "55 Lake Ave N",
"address_2": "UMMMC, Department of Psychiatry",
"city": "Worcester",
"state": "MA",
"country_code": "US",
"postal_code": "016550002",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.