Active NPI
Marion Lynn Wachtenheim, M.S.W.
- Clinical Social Worker
- Providence, RI
National Provider Identifier
1073636874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW00678
- Practice address
- 172 E Cushing St
Providence, RI 02906-2255 - Phone
- (401) 273-4840
- NPI assigned
- Apr 8, 2007
- Last updated
- Jul 10, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | ISW00678 | RI | Primary |
Addresses
Primary practice location
172 E Cushing St
Providence, RI 02906-2255
Mailing address
38 Paris St
Pawtucket, RI 02860-6129
Phone (401) 475-0785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 25, 2023 through Oct 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ISW00678 | RI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278720000000",
"number": "1073636874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 PARIS ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028606129",
"telephone_number": "401-475-0785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "172 E CUSHING ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029062255",
"telephone_number": "401-273-4840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACHTENHEIM",
"first_name": "MARION",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "M.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-08",
"last_updated": "2010-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "ISW00678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2010; 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.