Penelope Wilson, LCSW, ED.M

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

075598-1 Issued in NY

Practice address

30 Old Kings Hwy S
Darien, CT 06820-4551

Phone

(203) 300-6655

NPI assigned

Jan 4, 2010

Last updated

Jan 8, 2020By the provider in NPPES

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

Other names 1

• Penelope Wilson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 20, 2021 through Sep 20, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1262563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578441600000",
    "number": "1114257805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116",
            "city": "DARIEN",
            "state": "CT",
            "postal_code": "068200616",
            "telephone_number": "203-300-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 OLD KINGS HWY S",
            "city": "DARIEN",
            "state": "CT",
            "postal_code": "068204551",
            "telephone_number": "203-300-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "PENELOPE",
        "credential": "LCSW, ED.M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-04",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "075598-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PENELOPE",
            "last_name": "WILSON",
            "credential": "PWILSON LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Susan Westrup, O.D.
• Zachary Adam White, MPT
• Whole Harmony Nutrition, LLC
• Amanda Wien, LMSW
• Kim Stacy Wilson-Gerardi, M.S.P.T.
• Vanessa Wilson
• Cecile P Windels, MD
• Alexandra Wolfe, DMD
• Brian Thomas Wolfe, PT, DPT
• Kelly Anne Wolfe, PT, DPT

• Clinical Social Worker in Darien, CT
• Providers in Darien, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.

Verify at the official NPI Registry.