Individual provider Active NPI

Edward George Watson Jr., LCSW

  • Clinical Social Worker
  • New Providence, NJ
National Provider Identifier
1366993438
Registry record updated Aug 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05825000 Issued in NJ
Practice address
121 Chanlon Rd
New Providence, NJ 07974-1543
Phone
(908) 277-1808
NPI assigned
Oct 24, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 44SL05897800 NJ
Clinical Social Worker 1041C0700X 44SC05825000 NJ Primary

Addresses

Primary practice location

121 Chanlon Rd
New Providence, NJ 07974-1543

Mailing address

121 Chanlon Rd
New Providence, NJ 07974-1543

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
I20240112000488 NJ Practitioner - Clinical Social Worker 3779934971 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mental Health Association of Essex and Morris, Inc.Group PAC ID 5597654293, 14 clinicians

Practice addresses (Care Compare)

33 S Fullerton Ave
Montclair, NJ 07042-3358
Phone (973) 509-9777

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SL05897800NJMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Association of Essex and Morris, Inc. CurrentSince Dec 10, 2023 Accepting new patients

Locations

33 S Fullerton Ave
Montclair, NJ 07042
Phone (973) 509-9777

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.

NPI Registry JSON

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660348800000",
    "number": "1366993438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CHANLON RD",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "079741543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CHANLON RD",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "079741543",
            "telephone_number": "908-277-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "EDWARD",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-24",
        "last_updated": "2022-08-13",
        "certification_date": "2022-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL05897800",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05825000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Providence, NJ

Sources for this page

Verify at the official NPI Registry.