Active NPI
Roger Waitt, LICSW
- Clinical Social Worker
- Lynn, MA
National Provider Identifier
1922427772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 122790
- Practice address
- 18 Broadway Cir
Lynn, MA 01904 - Phone
- (978) 828-7315
- NPI assigned
- Apr 9, 2014
- Sex
- Male
- 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 | 122790 | MA | Primary |
Addresses
Primary practice location
18 Broadway Cir
Lynn, MA 01904
Mailing address
PO Box 8029
Lynn, MA 01904-0029
Phone (978) 869-3129
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201201003061 | MA | Practitioner - Clinical Social Worker | 7517378284 | Practice locations: Lynn, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
18 Broadway Cir
Lynn, MA 01904-2050
Phone (978) 828-7315
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122790 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1922427772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8029",
"city": "LYNN",
"state": "MA",
"postal_code": "019040029",
"telephone_number": "978-869-3129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 BROADWAY CIR",
"city": "LYNN",
"state": "MA",
"postal_code": "01904",
"telephone_number": "978-828-7315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAITT",
"first_name": "ROGER",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-09",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "122790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynn, 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.
- 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.