Renewals, name changes, and other actions

Request a Verification of Licensure

Provides official verification of a Board license or registration and is often required when seeking licensure in another state.

• Can be downloaded immediately and for free from https://checkahealthlicense.mass.gov
• If either the downloaded version is not acceptable to the recipient or an out-of-state verification form requires Board completion, complete the online application and provide the $15 non-refundable and non-transferable fee. (There will be a $23 handling charge for returned checks.)

Social Security Number or Date of Birth Update

What you need:

• Notarized affidavit to confirm your social security number and date of birth (this form can be found in the online application).
• For a new social security number: copy of Social Security Card or certified copy of documentation showing authorization for the assignment of a different social security number from the Social Security Administration or a court of law.
• For an incorrect social security number: copy of Social Security Card. If you don't have a card, you can use a recent tax return or W-2 from the last three years.
• Incorrect date of birth: copy of birth certificate or a current government-issued photo ID that has your date of birth (e.g., passport, driver’s license).

Name Changes

What you need:

• $27 non-refundable and non-transferable fee (There will be a $23 handling charge for returned checks.)

Supporting documents such as marriage certificate, divorce decree, or other court documents to be added to the online application.