NPIMap

Individual provider Active NPI

Gerald Joseph Matison, LICSW

  • Clinical Social Worker
  • Andover, MA
National Provider Identifier
1922188598
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
105016 Issued in MA
Practice address
2 Dundee Park Dr
Andover, MA 01810-3735
Phone
(978) 475-6950
Fax
(978) 499-0822
NPI assigned
Oct 17, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 105016 MA Primary
Clinical Social Worker 1041C0700X 0600 NH

Addresses

Primary practice location

2 Dundee Park Dr
Andover, MA 01810-3735

Mailing address

2 Dundee Park Dr
Andover, MA 01810-3735
Phone (978) 475-6950

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

LicenseStateTypeSpecialty
105016MAMDClinical Social Worker
0600NHMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922188598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 DUNDEE PARK DR",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103735",
            "telephone_number": "978-475-6950",
            "fax_number": "978-499-0822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DUNDEE PARK DR",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103735",
            "telephone_number": "978-475-6950",
            "fax_number": "978-499-0822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATISON",
        "first_name": "GERALD",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "105016",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "0600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.