Davidra Bazemore-Blue, MSW, LCSW-C

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

3200 Crain Hwy
Suite 203
Waldorf, MD 20603-4841

Phone

(240) 435-4708

NPI assigned

Jun 4, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Southern Maryland Counseling & Coaching, LLC

  • Clinical Social Worker
  • Waldorf, MD
  • NPI 1285177600
  NPD Authorized official

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1124465802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3261 OLD WASHINGTON RD STE 2020",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023231",
            "telephone_number": "202-997-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CRAIN HWY",
            "address_2": "SUITE 203",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034841",
            "telephone_number": "240-435-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZEMORE-BLUE",
        "first_name": "DAVIDRA",
        "credential": "MSW, LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-04",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589561803",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589561802",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589561800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Battling Barriers ABA Services LLC
• Bay Surgery Centers - Waldorf, LLC
• Bay Surgery Centers - Waldorf, LLC
• Bayou Estates LLC
• Bayview United Homecare Services LLC
• BBT Home Care and Staffing LLC
• Brandi Beam
• Daijah Beaner
• Laura Bearjar
• James William Beauchamp, D.C.

• Social Worker in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; 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.