Active NPI
Willis Blower, LCSW
- Clinical Social Worker
- Port Orange, FL
National Provider Identifier
1477900884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW12909
- Practice address
- 1160 Greenbriar Ave
Port Orange, FL 32127-6010 - Phone
- (386) 295-6386
- NPI assigned
- May 16, 2016
- Last updated
- Jun 3, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 | SW12909 | FL | Primary |
Addresses
Primary practice location
1160 Greenbriar Ave
Port Orange, FL 32127-6010
Mailing address
PO Box 9671
Daytona Beach, FL 32120-9671
Phone (386) 676-7130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW12909 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464912000000",
"number": "1477900884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9671",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321209671",
"telephone_number": "386-676-7130",
"fax_number": "386-676-7125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 GREENBRIAR AVE",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321276010",
"telephone_number": "386-295-6386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOWER",
"first_name": "WILLIS",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-16",
"last_updated": "2016-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW12909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.