Active NPI
Elizabeth Davenport, LICSW
- Clinical Social Worker
- Waltham, MA
National Provider Identifier
1497818116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 100214
- Practice address
- 740 Main St
Suite #105
Waltham, MA 02451 - Phone
- (781) 937-4172
- Fax
- (781) 734-0482
- NPI assigned
- Dec 18, 2006
- 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 | 100214 | MA | Primary |
Addresses
Primary practice location
740 Main St
Suite #105
Waltham, MA 02451
Mailing address
4 Angier Rd
Lexington, MA 02420
Phone (781) 862-4907
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P04346 | Other | BLUE CROSS BLUE SHIELD |
Other names 1
- Elizabeth E Davenport
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 |
|---|---|---|---|
| 100214 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497818116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 ANGIER RD",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "02420",
"telephone_number": "781-862-4907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 MAIN ST",
"address_2": "SUITE #105",
"city": "WALTHAM",
"state": "MA",
"postal_code": "02451",
"telephone_number": "781-937-4172",
"fax_number": "781-734-0482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVENPORT",
"first_name": "ELIZABETH",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "100214",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "P04346",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ELIZABETH",
"last_name": "DAVENPORT",
"middle_name": "E",
"credential": "LICSW",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.