Active NPI
Nakyung Im, LICSW,,LADC1,IABMCP
- Clinical Social Worker
- Brookline, MA
National Provider Identifier
1962530790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 103115
- Practice address
- 308A Harvard St
#2
Brookline, MA 02446-2900 - Phone
- (617) 738-9622
- Fax
- (617) 738-9623
- NPI assigned
- Mar 1, 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 | 103115 | MA | Primary |
Addresses
Primary practice location
308A Harvard St
#2
Brookline, MA 02446-2900
Mailing address
308A Harvard St
#2
Brookline, MA 02446-2900
Phone (617) 738-9622
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012700 | Other | MA | VALUEOPTIONS |
| 1858572 | Medicaid | MA | |
| 239881 | Other | MA | PRIVATE HEALTH CARE SYSTE |
| S024286 | Other | MA | CHAMPUS |
| 724940 | Other | MA | TUFTS HEALTH PLAN |
| 1898256 | Medicaid | MA | |
| 249058 | Other | MA | TRICARE |
| 62-03541 | Other | MA | UNITED BEHAVIOR HEALTH |
| 724940 | Other | MA | SECURE HORIZON |
| 2040351 | Other | MA | CIGNA HEALTH |
| 4504465 | Other | MA | AETNA HEALTH CARE |
| P03698 | Other | MA | BLUECROSSBLUESHIELD |
| 831200 | Other | MA | FIRST HEALTH GROUP CORP. |
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 |
|---|---|---|---|---|
| I20040325000856 | MA | Practitioner - Clinical Social Worker | 0941192009 | Practice locations: Brookline, MA; Quincy, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1971
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
308 A Harvard St
Suite 2
Brookline, MA 02446-2934
Phone (617) 738-9622
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103115 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1962530790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308A HARVARD ST",
"address_2": "#2",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462900",
"telephone_number": "617-738-9622",
"fax_number": "617-738-9623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308A HARVARD ST",
"address_2": "#2",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462900",
"telephone_number": "617-738-9622",
"fax_number": "617-738-9623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "NAKYUNG",
"name_prefix": "Miss",
"credential": "LICSW,,LADC1,IABMCP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "103115",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS",
"identifier": "012700",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1858572",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE HEALTH CARE SYSTE",
"identifier": "239881",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "S024286",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "724940",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1898256",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "249058",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIOR HEALTH",
"identifier": "62-03541",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECURE HORIZON",
"identifier": "724940",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTH",
"identifier": "2040351",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HEALTH CARE",
"identifier": "4504465",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "P03698",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH GROUP CORP.",
"identifier": "831200",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.