MEDICARE: DAVID BLAKE SHIPP LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102358	NY
2	104100000X	Social Worker	115935	NY

General Provider Information

NPI Number	:	1487367074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BLAKE SHIPP LMSW

Provider Business Mailing Address
First Line	:	33 LEWIS RD FL 2
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13905-1055
Country	:	US
Telephone Number	:	607-770-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	4417 VESTAL PKWY E
Second Line	:
City	:	VESTAL
State	:	NY
Zip	:	13850-3556
Country	:	US
Telephone Number	:	607-797-1251
Fax Number	:	607-729-4393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	03/16/2026

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Directions to “ DAVID BLAKE SHIPP LMSW” Practice Location

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