Active NPI
Brent Davison, LICSW
- Clinical Social Worker
- Gloucester, MA
National Provider Identifier
1679631527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 101369
- Practice address
- 92 Prospect St
Gloucester, MA 01930 - Phone
- (617) 605-2279
- Fax
- (978) 281-1739
- NPI assigned
- Dec 4, 2006
- 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 | 101369 | MA | Primary |
Addresses
Primary practice location
92 Prospect St
Gloucester, MA 01930
Mailing address
92 Prospect St
Gloucester, MA 01930-3710
Phone (617) 605-2279
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050921000829 | MA | Practitioner - Clinical Social Worker | 7618901430 | Practice locations: Gloucester, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1975
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
92 Prospect St
Gloucester, MA 01930-3710
Phone (978) 559-7099
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101369 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532390400000",
"number": "1679631527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "92 PROSPECT ST",
"city": "GLOUCESTER",
"state": "MA",
"postal_code": "019303710",
"telephone_number": "617-605-2279",
"fax_number": "978-281-1739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "92 PROSPECT ST",
"city": "GLOUCESTER",
"state": "MA",
"postal_code": "01930",
"telephone_number": "617-605-2279",
"fax_number": "978-281-1739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISON",
"first_name": "BRENT",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2018-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "101369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gloucester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.