Active NPI
Beverly M Simmons, LCSW
- Clinical Social Worker
- Raleigh, NC
National Provider Identifier
1942311626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C005387
- Practice address
- 4016 Barrett Dr Ste 104
Raleigh, NC 27609-6623 - Phone
- (919) 824-9102
- Fax
- (919) 883-4515
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
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 | C005387 | NC | Primary |
Addresses
Primary practice location
4016 Barrett Dr Ste 104
Raleigh, NC 27609-6623
Mailing address
4016 Barrett Dr Ste 104
Raleigh, NC 27609-6623
Phone (919) 824-9102
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C005387 | Other | NC | NC LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C005387 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1942311626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4016 BARRETT DR STE 104",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276096623",
"telephone_number": "919-824-9102",
"fax_number": "919-883-4515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4016 BARRETT DR STE 104",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276096623",
"telephone_number": "919-824-9102",
"fax_number": "919-883-4515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "BEVERLY",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C005387",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC LICENSE",
"identifier": "C005387",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.