Active NPI
Mitchell Mark Davidowitz, LICSW SOCIAL WORKER
- Clinical Social Worker
- Arlington, MA
National Provider Identifier
1821254715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 114375
- Practice address
- 94 Pleasant St
Arlington, MA 02476-6535 - Phone
- (781) 223-5879
- NPI assigned
- Jul 31, 2008
- 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 | 114375 | MA | Primary |
Addresses
Primary practice location
94 Pleasant St
Arlington, MA 02476-6535
Mailing address
11 Lockeland Ave
Arlington, MA 02476-6318
Phone (781) 223-5879
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114375 | Other | MA | COMMONWEALTH OF MASS LICSW LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 8, 2024 through Jul 8, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114375 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580169600000",
"number": "1821254715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 LOCKELAND AVE",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024766318",
"telephone_number": "781-223-5879",
"fax_number": "617-489-6125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "94 PLEASANT ST",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024766535",
"telephone_number": "781-223-5879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDOWITZ",
"first_name": "MITCHELL",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "LICSW SOCIAL WORKER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-31",
"last_updated": "2020-01-28",
"certification_date": "2020-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "114375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMONWEALTH OF MASS LICSW LICENSE NUMBER",
"identifier": "114375",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Arlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.