Active NPI
Kathleen M Wood Bacon, LICSW
- Social Worker
- Windham, NH
National Provider Identifier
1124072996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LICSW1238
- Practice address
- 183 Rockingham Road
Windham, NH 03087 - Phone
- (603) 434-9937
- Fax
- (603) 434-0427
- NPI assigned
- May 19, 2006
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LICSW1238 | NH | Primary |
Addresses
Primary practice location
183 Rockingham Road
Windham, NH 03087
Mailing address
754 Chestnut St
Suite 2
Manchester, NH 03104-3012
Phone (603) 836-5003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 2, 2024 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW1238 | NH | MD | Social Worker |
| 1238 | NH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468195200000",
"number": "1124072996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "754 CHESTNUT ST",
"address_2": "SUITE 2",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031043012",
"telephone_number": "603-836-5003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "183 ROCKINGHAM ROAD",
"city": "WINDHAM",
"state": "NH",
"postal_code": "03087",
"telephone_number": "603-434-9937",
"fax_number": "603-434-0427"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD BACON",
"first_name": "KATHLEEN",
"middle_name": "M",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2016-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NH",
"license": "LICSW1238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windham, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; 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.