Individual provider Active NPI

Davis Tannenbaum, LCSW

  • Clinical Social Worker
  • Lakewood, NJ
National Provider Identifier
1912534272
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05903600 Issued in NJ
Practice address
1771 Madison Ave
Lakewood, NJ 08701-1242
Phone
(732) 364-2144
NPI assigned
Mar 26, 2020
Last updated
Mar 26, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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 44SC05903600 NJ Primary

Addresses

Primary practice location

1771 Madison Ave
Lakewood, NJ 08701-1242

Mailing address

958 Claire Dr
Lakewood, NJ 08701-5517
Phone (718) 288-8354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20200513001822 NJ Practitioner - Clinical Social Worker 1557792256 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1771 Madison Ave
Lakewood, NJ 08701-1251

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC05903600NJMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lakewood Resource and Referral Center Inc CurrentSince May 1, 2020 Accepting new patients
Lakewood Resource and Referral Center, Inc. CurrentSince May 1, 2020 Accepting new patients

Locations

1771 Madison Ave
Lakewood, NJ 08701
Phone (732) 364-2144

Organizations & group practices 2

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": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1912534272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "958 CLAIRE DR",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015517",
            "telephone_number": "718-288-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011242",
            "telephone_number": "732-364-2144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNENBAUM",
        "first_name": "DAVIS",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05903600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.