Active NPI
Brian Patterson Southworth, LICSW
- Clinical Social Worker
- Burlington, VT
National Provider Identifier
1629584875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0890000563
- Practice address
- 76 Glen Rd
Burlington, VT 05406-4009 - Phone
- (802) 864-7467
- NPI assigned
- Dec 26, 2017
- Sex
- Male
- 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 | 0890000563 | VT | Primary |
Addresses
Primary practice location
76 Glen Rd
Burlington, VT 05406-4009
Mailing address
76 Glen Rd
Burlington, VT 05406-4009
Phone (802) 864-7467
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0890000563 | Medicaid | VT | |
| 1041C0700X | Medicaid | VT |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0890000563 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1629584875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 GLEN RD",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054064009",
"telephone_number": "802-864-7467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 GLEN RD",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054064009",
"telephone_number": "802-864-7467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHWORTH",
"first_name": "BRIAN",
"middle_name": "PATTERSON",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-26",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "0890000563",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0890000563",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1041C0700X",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.