Individual provider Active NPI

Mary Elizabeth Gibbons, LICSW

  • Clinical Social Worker
  • Framingham, MA
National Provider Identifier
1942388483
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1015867 Issued in MA
Practice address
61 Lincoln St Ste 203
Framingham, MA 01702-8264
Phone
(781) 666-2711
Fax
(781) 666-2712
NPI assigned
Nov 1, 2006
Last updated
May 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1015867 MA Primary

Addresses

Primary practice location

61 Lincoln St Ste 203
Framingham, MA 01702-8264

Mailing address

61 Hersey St
Hingham, MA 02043-4609
Phone (617) 774-6021

Other practice location 1

460 Quincy Ave
Quincy, MA 02169-8130
Phone (617) 774-6021

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080517000024 MA Practitioner - Clinical Social Worker 5496824443 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1015867MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Mental Health Center, Inc. CurrentSince Jul 1, 1990 Accepting new patients
Child and Family Psychological Services, PLLC Clinical CurrentSince Dec 9, 2019 Accepting new patients

Locations

1501 Washington St
Braintree, MA 02184
Phone (617) 745-2709

89 Access Rd
Ste 24
Norwood, MA 02062
Phone (781) 336-5040

460 Quincy Ave
Quincy, MA 02169
Phone (617) 770-4000

500 Victory Rd
Quincy, MA 02171
Phone (617) 774-1040

859 Willard St
Ste 430
Quincy, MA 02169
Phone (617) 847-1909

169 Libbey Park
Ste 2
Weymouth, MA 02189
Phone (781) 682-1060

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1942388483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 HERSEY ST",
            "city": "HINGHAM",
            "state": "MA",
            "postal_code": "020434609",
            "telephone_number": "617-774-6021",
            "fax_number": "617-770-3749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 LINCOLN ST STE 203",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017028264",
            "telephone_number": "781-666-2711",
            "fax_number": "781-666-2712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "460 Quincy Ave",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "MA",
            "postal_code": "021698130",
            "country_code": "US",
            "telephone_number": "617-774-6021",
            "fax_number": "617-770-3749",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1015867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Framingham, MA

Sources for this page

Verify at the official NPI Registry.