Sandra Ann Theodor, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1029070 Issued in MA

Practice address

151 Mystic Ave
Ste 6, DCS Mental Health Inc.
Medford, MA 02155-4632

Phone

(781) 396-1199

NPI assigned

Apr 18, 2007

Last updated

Aug 4, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialty

Clinical Social Worker

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DCS Mental Health, IncGroup PAC ID 8820992456, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DCS Mental Health, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Medford, MA
  • NPI 1215912894
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375574400000",
    "number": "1891911749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 CRANMORE LN",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021761507",
            "telephone_number": "781-662-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 MYSTIC AVE",
            "address_2": "STE 6, DCS MENTAL HEALTH INC.",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554632",
            "telephone_number": "781-396-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODOR",
        "first_name": "SANDRA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2013-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1029070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Medford, MA
• Providers in Medford, 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 Aug 4, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.