Individual provider Active NPI

Sheri Martha Gibson-Broyles, LCSW

  • Clinical Social Worker
  • Sparta, NJ
National Provider Identifier
1316017197
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05176500 Issued in NJ
Practice address
48 Woodport Rd
Lower Level
Sparta, NJ 07871-2424
Phone
(973) 729-5559
Fax
(973) 729-2600
NPI assigned
Nov 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC05176500 NJ Primary

Addresses

Primary practice location

48 Woodport Rd
Lower Level
Sparta, NJ 07871-2424

Mailing address

48 Woodport Rd
Lower Level
Sparta, NJ 07871-2424
Phone (973) 729-5559

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050419000259 NJ Practitioner - Clinical Social Worker 2860430121 Practice locations: Sparta, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

171 Woodport Rd
Suite B
Sparta, NJ 07871-2633
Phone (973) 729-5559

171 Woodport Rd B
Sparta, NJ 07871-2633

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC05176500NJMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316017197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 WOODPORT RD",
            "address_2": "LOWER LEVEL",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078712424",
            "telephone_number": "973-729-5559",
            "fax_number": "973-729-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 WOODPORT RD",
            "address_2": "LOWER LEVEL",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078712424",
            "telephone_number": "973-729-5559",
            "fax_number": "973-729-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON-BROYLES",
        "first_name": "SHERI",
        "middle_name": "MARTHA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05176500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, NJ

Sources for this page

Verify at the official NPI Registry.