Individual provider Active NPI

William C. Devery, L.C.S.W.

  • Clinical Social Worker
  • Staten Island, NY
National Provider Identifier
1770681900
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R027896-1 Issued in NY
Practice address
1345 N Railroad Ave
Staten Island, NY 10306-2348
Phone
(718) 351-0555
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R027896-1 NY Primary
Clinical Social Worker 1041C0700X SC 07460 NJ

Addresses

Primary practice location

1345 N Railroad Ave
Staten Island, NY 10306-2348

Mailing address

22 Cornell Dr
East Brunswick, NJ 08816-5318
Phone (732) 698-0280

Other identifiers 1

IdentifierTypeStateIssuer
0019274OtherNYGHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150401000961 NY Practitioner - Clinical Social Worker 6901123983 Practice locations: Staten Island, NY
I20210225002196 NJ Practitioner - Clinical Social Worker 6901123983 Practice locations: Helmetta, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

17 George W Helme Dr
Helmetta, NJ 08828-1172
Phone (718) 351-0555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC 07460NJMDClinical Social Worker
R027896-1NYMDClinical Social Worker
027896NYMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405900800000",
    "number": "1770681900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 CORNELL DR",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088165318",
            "telephone_number": "732-698-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 N RAILROAD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103062348",
            "telephone_number": "718-351-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVERY",
        "first_name": "WILLIAM",
        "middle_name": "C.",
        "name_prefix": "Mr.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R027896-1",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "SC 07460",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0019274",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.