Active NPI
Diane Smith Brissey, LCSWC
- Clinical Social Worker
- Berlin, MD
National Provider Identifier
1407958655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 08289
- Practice address
- 124 N Main St
Berlin, MD 21811-1060 - Phone
- (410) 641-4598
- NPI assigned
- Sep 1, 2006
- Reactivated
- Jun 10, 2010
- 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 | 08289 | MD | Primary |
Addresses
Primary practice location
124 N Main St
Berlin, MD 21811-1060
Mailing address
124 N Main St
P.O. Box 925
Berlin, MD 21811-1060
Phone (410) 641-4598
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222731200 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2026 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276128000000",
"number": "1407958655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 N MAIN ST",
"address_2": "P.O. BOX 925",
"city": "BERLIN",
"state": "MD",
"postal_code": "218111060",
"telephone_number": "410-641-4598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 N MAIN ST",
"city": "BERLIN",
"state": "MD",
"postal_code": "218111060",
"telephone_number": "410-641-4598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISSEY",
"first_name": "DIANE",
"middle_name": "SMITH",
"name_prefix": "Mrs.",
"credential": "LCSWC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-01",
"last_updated": "2010-06-10",
"deactivation_date": "2010-05-26",
"reactivation_date": "2010-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "08289",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "222731200",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berlin, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.