Individual provider Active NPI

David Thayer, LICSW

  • Clinical Social Worker
  • Providence, RI
National Provider Identifier
1881621597
Registry record updated Jul 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW01440 Issued in RI
Practice address
520 Hope St
Providence, RI 02906-2532
Phone
(401) 276-4155
NPI assigned
Jun 27, 2006
Last updated
Jul 25, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2008

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 ISW01440 RI Primary

Addresses

Primary practice location

520 Hope St
Providence, RI 02906-2532

Mailing address

528 N Main St
Providence, RI 02904-5757

Other identifiers 5

IdentifierTypeStateIssuer
DT50329MedicaidRI
413050OtherRIBLUE CHIP
30911-4OtherRIBLUE CROSS
62-38134OtherRIUNITED BEHAVIORAL HEALTH
1104847946OtherRITHE PROVIDENCE CENTER NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20250328000345 NY Practitioner - Clinical Social Worker 1254232499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

19 Greenridge Ave
White Plains, NY 10605-1201
Phone (914) 965-3700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ISW01440RIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Julia Dyckman Andrus Memorial, Inc. CurrentSince Feb 1, 2025 Accepting new patients
The Providence Center Inc Clinical PastSince Jan 21, 2013 Accepting new patients
The Providence Center Past Accepting new patients

Locations

19 Greenridge Ave
White Plains, NY 10605
Phone (914) 949-7680

1156 N Broadway
Yonkers, NY 10701
Phone (914) 965-3700

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216944000000",
    "number": "1881621597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029045757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 HOPE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062532",
            "telephone_number": "401-276-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAYER",
        "first_name": "DAVID",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2008-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DT50329",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "413050",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "30911-4",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "62-38134",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE PROVIDENCE CENTER NPI",
            "identifier": "1104847946",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.