Individual provider Active NPI

Dedan Davenport

  • Clinical Social Worker
  • White Plains, NY
National Provider Identifier
1659758274
Registry record updated May 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
19 Greenridge Ave
White Plains, NY 10605-1201
Phone
(914) 949-7680
NPI assigned
May 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

19 Greenridge Ave
White Plains, NY 10605-1201

Mailing address

60 Newtown Rd # 146
Danbury, CT 06810-6257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20250924001912 CT Practitioner - Clinical Social Worker 9436654134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wheeler Clinic IncGroup PAC ID 0345147153, 105 clinicians

Practice addresses (Care Compare)

855 Lakewood Rd
Waterbury, CT 06704-5408
Phone (860) 793-3500

91 Northwest Dr
Plainville, CT 06062-1534
Phone (860) 793-3500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15732CTMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wheeler Clinic Inc CurrentSince Aug 29, 2025 Accepting new patients
Wheeler Clinic Inc CurrentSince Aug 29, 2025 Accepting new patients
Julia Dyckman Andrus Memorial, Inc. PastSince Apr 1, 2005 Accepting new patients

Locations

91 Northwest Dr
Plainville, CT 06062
Phone (860) 793-3871

Interoperability endpoints

  • Direct secure messaging: dedan.davenport.p1@direct.wheelerclinic.nextgenshare.com

Organizations & group practices 3

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": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430697600000",
    "number": "1659758274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 NEWTOWN RD # 146",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 GREENRIDGE AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051201",
            "telephone_number": "914-949-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "DEDAN",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Plains, NY

Sources for this page

Verify at the official NPI Registry.