Active NPI
Diane Joan Dmytryk, LICSW
- Clinical Social Worker
- Medford, MA
National Provider Identifier
1942409362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1015702
- Practice address
- 66 Marston St
Medford, MA 02155-4469 - Phone
- (781) 395-5724
- Fax
- (484) 450-4144
- NPI assigned
- Jul 16, 2007
- Sex
- Female
- 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 | 1015702 | MA | Primary |
Addresses
Primary practice location
66 Marston St
Medford, MA 02155-4469
Mailing address
66 Marston St
Medford, MA 02155-4469
Phone (781) 395-5724
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P04659 | Other | MA | BLUE CROSS BLUE SHIELD |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184544000000",
"number": "1942409362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 MARSTON ST",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554469",
"telephone_number": "781-395-5724",
"fax_number": "484-450-4144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 MARSTON ST",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554469",
"telephone_number": "781-395-5724",
"fax_number": "484-450-4144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DMYTRYK",
"first_name": "DIANE",
"middle_name": "JOAN",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-16",
"last_updated": "2007-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1015702",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "P04659",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.