Active NPI
Patricia Gale Wallerstein, MSW LICSW
- Clinical Social Worker
- Amesbury, MA
National Provider Identifier
1093891871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1022652
- Practice address
- 100 Main Street
Suite 11
Amesbury, MA 01913 - Phone
- (978) 388-5311
- Fax
- (978) 388-5571
- NPI assigned
- Oct 27, 2006
- Last updated
- Jul 8, 2007
- 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 | 1022652 | MA | Primary |
Addresses
Primary practice location
100 Main Street
Suite 11
Amesbury, MA 01913
Mailing address
11 10TH Street
Newbury, MA 01951
Phone (978) 463-6901
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PP0352 | Other | MA | BCBS |
| 1890247 | Medicaid | MA | |
| 102265 | Other | MA | TUFTS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 18, 2019 through Apr 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1022652 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093891871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 10TH STREET",
"city": "NEWBURY",
"state": "MA",
"postal_code": "01951",
"telephone_number": "978-463-6901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MAIN STREET",
"address_2": "SUITE 11",
"city": "AMESBURY",
"state": "MA",
"postal_code": "01913",
"telephone_number": "978-388-5311",
"fax_number": "978-388-5571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLERSTEIN",
"first_name": "PATRICIA",
"middle_name": "GALE",
"name_prefix": "Ms.",
"credential": "MSW LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1022652",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "PP0352",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1890247",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "102265",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amesbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.