Active NPI
Wanderley Timas
- School Social Worker
- South Boston, MA
National Provider Identifier
1043706187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- 219980
- Practice address
- 95 G St
South Boston, MA 02127-2920 - Phone
- (617) 635-9870
- NPI assigned
- Jul 2, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | 219980 | MA | Primary |
Addresses
Primary practice location
95 G St
South Boston, MA 02127-2920
Mailing address
95 G St
South Boston, MA 02127-2920
Phone (857) 492-6346
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 219980 | MA | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530489600000",
"number": "1043706187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 G ST",
"city": "SOUTH BOSTON",
"state": "MA",
"postal_code": "021272920",
"telephone_number": "857-492-6346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "95 G ST",
"city": "SOUTH BOSTON",
"state": "MA",
"postal_code": "021272920",
"telephone_number": "617-635-9870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMAS",
"first_name": "WANDERLEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-02",
"last_updated": "2018-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "MA",
"license": "219980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.