Randi Simone Davis, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

122616 Issued in MA

Practice address

75 Malcolm X Blvd
Boston, MA 02120-3106

Phone

(617) 635-8970

NPI assigned

Aug 24, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1366923633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 PAGE ST UNIT 204",
            "city": "STOUGHTON",
            "state": "MA",
            "postal_code": "020726028",
            "telephone_number": "978-729-4437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 MALCOLM X BLVD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021203106",
            "telephone_number": "617-635-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "RANDI",
        "middle_name": "SIMONE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-24",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "221957",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "122616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Joseph Davis, PA-C
• Michelle Ruth Davis, M.D.
• Morgan Gabrielle Davis
• Patrick Davis
• Peter Evan Davis, M.D.
• Robert Glen Davis, M.D.
• Ryan Kory Davis, M.D.
• Samantha Davis
• Shane Michael Davis, MD
• Shawn Renee Davis, RDH

• Clinical Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.