Drift E Mavyn, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089.0134630 Issued in VT

Practice address

74 Grafton Rd.
Townshend, VT 05353

Phone

(802) 321-5066

Fax

(802) 210-3972

NPI assigned

May 9, 2022

Last updated

Oct 3, 2024By the provider in NPPES

Sex

Unspecified or another gender identity

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Drift Mavyn Professional name

Medicare fee-for-service enrollment

Enrolled in VT

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

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Drift Mavyn Licsw LLC

  • Clinical Social Worker
  • Townshend, VT
  • NPI 1134842909
  Medicare reassignment NPD Authorized official
• Brattleboro Retreat

  • Psychiatric Hospital
  • Brattleboro, VT
  • NPI 1730185232
  Medicare reassignment

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

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1316683758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157",
            "city": "TOWNSHEND",
            "state": "VT",
            "postal_code": "053530157",
            "telephone_number": "802-321-5066",
            "fax_number": "802-210-3972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 GRAFTON RD.",
            "city": "TOWNSHEND",
            "state": "VT",
            "postal_code": "05353",
            "telephone_number": "802-321-5066",
            "fax_number": "802-210-3972"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "126 Brookline Rd",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "VT",
            "postal_code": "051438586",
            "country_code": "US",
            "telephone_number": "802-321-5066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAVYN",
        "first_name": "DRIFT",
        "middle_name": "E",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2022-05-09",
        "last_updated": "2024-10-03",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.0134630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6712069",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP INSURANCE",
            "identifier": "MVP0551",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS VERMONT",
            "identifier": "5212947",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DRIFT",
            "last_name": "MAVYN",
            "credential": "MSW, LICSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Danica GZL Lobaton Coppolo, RN, FNP-C
• Catherine Jean Lumenello, D.AC., L.AC.
• Lynn Elise Madsen, MD
• Mario Hasaj, LLC
• Sabrina Martinez
• Louise McDevitt, APRN, FNP, ANP
• Richard A Meyer, MD
• Warren R Montgomery, PAC
• Joshua Adam Rosenblum, PA-C
• Elise Kathleen Sawyer Kraus, RN

• Clinical Social Worker in Townshend, VT
• Providers in Townshend, VT by specialty
• Clinical Social Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.