Mary Lukens Wyman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21684 Issued in CA

Practice address

4361 Latham St Ste 220
Riverside, CA 92501-1767

Phone

(858) 279-1223

NPI assigned

Jul 15, 2021

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 CA

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

Specialty

Clinical Social Worker

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Eagan Medical Group IncGroup PAC ID 6608136056, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eagan Medical Group, Inc.

  • Psychiatry Physician
  • Huntington Beach, CA
  • NPI 1265946289
  Medicare reassignment Care Compare group NPD
• Pacific Coast Psychiatric Associates Inc

  • Clinical Psychologist
  • Scottsdale, AZ
  • NPI 1023125465

  CA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1043882244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4361 LATHAM ST STE 220",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925011767",
            "telephone_number": "858-279-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4361 LATHAM ST STE 220",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925011767",
            "telephone_number": "858-279-1223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050 W Chapman Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928682649",
            "country_code": "US",
            "telephone_number": "214-751-8987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "MARY",
        "middle_name": "LUKENS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "21684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Wu, DPT
• Leslie Wu
• Christopher Don Wyatt, LCSW
• Katherine Wyatt, NP
• Wylie Center - a Psychological Corporation
• Theodore Eugene Wyman, M.D.
• Lucas Ryan Wymore, MD
• Joanne T. Wyszomirski-Witkowski, MD
• Novanh Scott Xayarath, MFT
• Xia L.Liu Professional Dental Corp

• Clinical Social Worker in Riverside, CA
• Providers in Riverside, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.