Active NPI
Jennifer Davis, LISW
- Clinical Social Worker
- Dayton, OH
National Provider Identifier
1124163670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.0002316
- Practice address
- 4004 E 3Rd St
Dayton, OH 45403-2242 - Phone
- (937) 474-8391
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- No
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 | I.0002316 | OH | Primary |
Addresses
Primary practice location
4004 E 3Rd St
Dayton, OH 45403-2242
Mailing address
4004 E 3Rd St
Dayton, OH 45403-2242
Phone (937) 475-8391
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000012188 | Other | ND | ANTHEM |
| 007792009 | Other | OH | MAGELLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I.0002316 | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Clinical | Current | Accepting new patients |
| Dene S Berman Lifespan Counseling Associates | Clinical | Past | Accepting new patients |
Locations
20 S 3rd St
Ste 210
Columbus, OH 43215
Phone (614) 208-4973
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Beavercreek, OH
- NPI 1407991862
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746489600000",
"number": "1124163670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4004 E 3RD ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454032242",
"telephone_number": "937-475-8391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4004 E 3RD ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454032242",
"telephone_number": "937-474-8391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JENNIFER",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2025-05-06",
"certification_date": "2025-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.0002316",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000012188",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "007792009",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.