Individual provider Active NPI

Don Thaddeus Galvin III, LMSW

  • Clinical Social Worker
  • Saint Clair Shores, MI
National Provider Identifier
1083046122
Registry record updated Jan 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801095781 Issued in MI
Practice address
22811 Greater Mack Ave
L-2
Saint Clair Shores, MI 48080-2021
Phone
(586) 335-2006
Fax
(586) 279-3886
NPI assigned
Jul 31, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2017

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 6801095781 MI Primary

Addresses

Primary practice location

22811 Greater Mack Ave
L-2
Saint Clair Shores, MI 48080-2021

Mailing address

22811 Greater Mack Ave
L-2
Saint Clair Shores, MI 48080-2021
Phone (586) 335-2006

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801095781MIMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483488000000",
    "number": "1083046122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "address_2": "L-2",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-335-2006",
            "fax_number": "586-279-3886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "address_2": "L-2",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-335-2006",
            "fax_number": "586-279-3886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALVIN",
        "first_name": "DON",
        "middle_name": "THADDEUS",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-31",
        "last_updated": "2017-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801095781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.