Active NPI
Clay Nelson White, LICSW
- Clinical Social Worker
- Brookline, MA
National Provider Identifier
1992896138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1020269
- Practice address
- 1371 Beacon St
Suite 304
Brookline, MA 02446-4905 - Phone
- (617) 983-9811
- Fax
- (617) 267-3667
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- 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 | 1020269 | MA | Primary |
Addresses
Primary practice location
1371 Beacon St
Suite 304
Brookline, MA 02446-4905
Mailing address
111 Perkins St
#288
Jamaica Plain, MA 02130-4313
Phone (617) 983-9811
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1854160 | Medicaid | MA |
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 |
|---|---|---|---|---|
| I20041014000353 | MA | Practitioner - Clinical Social Worker | 0648230664 | Practice locations: Brookline, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1371 Beacon St
Suite 304
Brookline, MA 02446-4994
Phone (617) 983-9811
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1020269 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268697600000",
"number": "1992896138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 PERKINS ST",
"address_2": "#288",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021304313",
"telephone_number": "617-983-9811",
"fax_number": "617-267-3667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1371 BEACON ST",
"address_2": "SUITE 304",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024464905",
"telephone_number": "617-983-9811",
"fax_number": "617-267-3667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "CLAY",
"middle_name": "NELSON",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2010-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1020269",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1854160",
"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 Mar 16, 2010; 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.