Active NPI
Krystle M Davis
- Clinical Social Worker
- Montclair, NJ
National Provider Identifier
1194283374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SL05770200
- Practice address
- 18-20 Lackawanna PLZ
Montclair, NJ 07042-3642 - Phone
- (862) 210-9485
- NPI assigned
- Mar 7, 2019
- 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 | 44SL05770200 | NJ | Primary |
Addresses
Primary practice location
18-20 Lackawanna PLZ
Montclair, NJ 07042-3642
Mailing address
38 Hilton St
East Orange, NJ 07017-1845
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 |
|---|---|---|---|
| 44SL05770200 | NJ | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| I Still Love You Therapy & Wellness Center | Clinical | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Montclair, NJ
- NPI 1285487694
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1194283374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 HILTON ST",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "070171845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18-20 LACKAWANNA PLZ",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070423642",
"telephone_number": "862-210-9485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KRYSTLE",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-07",
"last_updated": "2024-04-08",
"certification_date": "2024-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SL05770200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montclair, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.