Active NPI
Jacqueline Wibert
- Clinical Social Worker
- Maynard, MA
National Provider Identifier
1093487480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 23419
- Practice address
- 141 Parker St Ste 306
Maynard, MA 01754-2180 - Phone
- (866) 991-2103
- NPI assigned
- Oct 4, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 23419 | MD | Primary |
Addresses
Primary practice location
141 Parker St Ste 306
Maynard, MA 01754-2180
Mailing address
141 Parker St Ste 306
Maynard, MA 01754-2180
Phone (866) 991-2103
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23419 | Other | MD | STATE LICENSE |
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 |
|---|---|---|---|
| 23419 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633305600000",
"number": "1093487480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 PARKER ST STE 306",
"city": "MAYNARD",
"state": "MA",
"postal_code": "017542180",
"telephone_number": "866-991-2103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 PARKER ST STE 306",
"city": "MAYNARD",
"state": "MA",
"postal_code": "017542180",
"telephone_number": "866-991-2103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIBERT",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-04",
"last_updated": "2021-10-04",
"certification_date": "2021-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "23419",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "23419",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maynard, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.