Constance Wynne, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

114240 Issued in MA

Practice address

1059 Tremont St
Boston, MA 02120-2149

Phone

(310) 488-6867

NPI assigned

Apr 30, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420588800000",
    "number": "1043486095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 TREMONT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021202149",
            "telephone_number": "310-488-6867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1059 TREMONT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021202149",
            "telephone_number": "310-488-6867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "CONSTANCE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-30",
        "last_updated": "2015-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "114240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blair Johnson Wylie, MD
• John V. Wylie Jr., MD
• Amanda Wynn, LCSW
• Edwinna Wynn, MSW
• Michelle Wynn
• Julie A Wyrobek, M.D.
• Christina Wysocki, PA-C
• Edward P Wysocki, DMD
• Mikayla D Wysocki, PA-C
• Nicolas Wyvekens, MD

• Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.