Active NPI
Kerry D Mitchell, PHD
- Clinical Social Worker
- Chestnut Hill, MA
National Provider Identifier
1912005604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 101476
- Practice address
- 500 Beacon St
Chestnut Hill, MA 02467-1168 - Phone
- (617) 989-0047
- Fax
- (617) 244-6447
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 101476 | MA | Primary |
Addresses
Primary practice location
500 Beacon St
Chestnut Hill, MA 02467-1168
Mailing address
500 Beacon St
Chestnut Hill, MA 02467-1168
Phone (617) 989-0047
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 25, 2024 through Nov 25, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101476 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912005604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 BEACON ST",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024671168",
"telephone_number": "617-989-0047",
"fax_number": "617-244-6447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 BEACON ST",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024671168",
"telephone_number": "617-989-0047",
"fax_number": "617-244-6447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "KERRY",
"middle_name": "D",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "101476",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chestnut Hill, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.