Renita Dercel Davis, MSW, MED

Primary specialty

School Social WorkerTaxonomy code 1041S0200X

Practice address

200 W Country Walk Dr
Round Lake Beach, IL 60073-4009

Phone

(847) 668-7456

Fax

(847) 356-1306

NPI assigned

Apr 5, 2021

Last updated

Jul 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1184203341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 N MUNICIPAL WAY UNIT 991",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600737939",
            "telephone_number": "847-668-7456",
            "fax_number": "847-356-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W COUNTRY WALK DR",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600734009",
            "telephone_number": "847-668-7456",
            "fax_number": "847-356-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "RENITA",
        "middle_name": "DERCEL",
        "name_prefix": "Mrs.",
        "credential": "MSW, MED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-05",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• School Social Worker in Round Lake Beach, IL
• Providers in Round Lake Beach, IL by specialty
• School Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.