Active NPI
Carmen Wilson, MSW, LICSW
- Social Worker
- Oak Bluffs, MA
National Provider Identifier
1104947696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 140745
- Practice address
- 1 Tradewinds Rd
Oak Bluffs
Oak Bluffs, MA 02557-1325 - Phone
- (508) 693-7403
- NPI assigned
- Apr 2, 2007
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 140745 | MA | Primary |
Addresses
Primary practice location
1 Tradewinds Rd
Oak Bluffs
Oak Bluffs, MA 02557-1325
Mailing address
PO Box 758
West Tisbury, MA 02575-0758
Phone (508) 693-7403
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BCBS | Other | MA | LICSW |
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 |
|---|---|---|---|
| 140745 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104947696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 758",
"city": "WEST TISBURY",
"state": "MA",
"postal_code": "025750758",
"telephone_number": "508-693-7403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 TRADEWINDS RD",
"address_2": "OAK BLUFFS",
"city": "OAK BLUFFS",
"state": "MA",
"postal_code": "025571325",
"telephone_number": "508-693-7403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CARMEN",
"name_prefix": "Ms.",
"credential": "MSW, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "140745",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICSW",
"identifier": "BCBS",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Bluffs, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.