Active NPI
Sean P Daughtry, L.I.C.S.W.
- Clinical Social Worker
- Salem, MA
National Provider Identifier
1770624918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 110632
- Practice address
- One Salem Green
Suite 400
Salem, MA 01970 - Phone
- (978) 535-6043
- NPI assigned
- Feb 9, 2007
- 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 | 110632 | MA | Primary |
Addresses
Primary practice location
One Salem Green
Suite 400
Salem, MA 01970
Mailing address
One Salem Green
Suite 400
Salem, MA 01970
Phone (978) 535-6043
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110095822A | Medicaid | MA |
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 |
|---|---|---|---|---|
| I20051018000891 | MA | Practitioner - Clinical Social Worker | 2769408855 | Practice locations: Beverly, MA; Peabody, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Peabody, MA 01960
Phone (617) 676-5789
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110632 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395619200000",
"number": "1770624918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE SALEM GREEN",
"address_2": "SUITE 400",
"city": "SALEM",
"state": "MA",
"postal_code": "01970",
"telephone_number": "978-535-6043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ONE SALEM GREEN",
"address_2": "SUITE 400",
"city": "SALEM",
"state": "MA",
"postal_code": "01970",
"telephone_number": "978-535-6043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAUGHTRY",
"first_name": "SEAN",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "L.I.C.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2014-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "110632",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110095822A",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; 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.