Wendy Ellen Mita, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW11682 Issued in FL

Practice address

11120 S Crown Way Ste 1
Wellington, FL 33414-8718

Phone

(561) 790-1191

NPI assigned

Aug 19, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Wendy Ellen Bloom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shine Medical Providers PC

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1538894050
  NPD (past)

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1144477480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 HACKENSACK AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016304",
            "telephone_number": "201-488-6678",
            "fax_number": "201-488-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11120 S CROWN WAY STE 1",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334148718",
            "telephone_number": "561-790-1191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 John F Kennedy Pkwy",
            "address_purpose": "LOCATION",
            "city": "Short Hills",
            "state": "NJ",
            "postal_code": "070782704",
            "country_code": "US",
            "telephone_number": "201-488-6678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITA",
        "first_name": "WENDY",
        "middle_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-19",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC04931900",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW11682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WENDY",
            "last_name": "BLOOM",
            "middle_name": "ELLEN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monica Miner, LMHC
• Olivia Minicucci, MS, RD
• Courtney Minors
• Ximena Minuche
• Shifat Hossain Mirza, DDS
• Crusita S Mitchell, RPH
• Erica Gasho Mitchell, FNP
• Leanne Mitchell, DIPL. L.AC, LMT, ES
• Sarah Elizabeth Mitchell, D.O.
• Modern Dental Smiles of Wellington PA

• Clinical Social Worker in Wellington, FL
• Providers in Wellington, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.