Active NPI
Deirdre M Danahar, LICSW
- Clinical Social Worker
- Jackson, MS
National Provider Identifier
1174007884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 110607
- Practice address
- 4410 Brook Dr
Jackson, MS 39206-5932 - Phone
- (601) 362-8288
- NPI assigned
- Sep 18, 2018
- Last updated
- Sep 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C7111 | MS | |
| Clinical Social Worker | 1041C0700X | 110607 | MA | Primary |
Addresses
Primary practice location
4410 Brook Dr
Jackson, MS 39206-5932
Mailing address
4410 Brook Dr
Jackson, MS 39206-5932
Phone (601) 362-8288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110607-SW-LICSW | Other | MA | DIVISION OF PROFESSIONAL LICENSURE, BOARD OF REGISTRATION OF SOCIAL WORKERS |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110607 | MA | MD | Clinical Social Worker |
| C7111 | MS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537228800000",
"number": "1174007884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4410 BROOK DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392065932",
"telephone_number": "601-362-8288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4410 BROOK DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392065932",
"telephone_number": "601-362-8288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANAHAR",
"first_name": "DEIRDRE",
"middle_name": "M",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-18",
"last_updated": "2018-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "C7111",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "110607",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIVISION OF PROFESSIONAL LICENSURE, BOARD OF REGISTRATION OF SOCIAL WORKERS",
"identifier": "110607-SW-LICSW",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.