Tele Wilson-Bahoun

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

128563 Issued in MA

Practice address

875 Massachusetts Ave Ste 84
Cambridge, MA 02139-3071

Phone

(802) 500-2862

Fax

(617) 354-4452

NPI assigned

Oct 16, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tele.wilson-bahoun.1@28623.direct.athenahealth.com

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.

• Optum Behavioral Care of Connecticut, P.C.

  • Counseling Psychologist
  • Newburyport, MA
  • NPI 1831970904
  Medicare reassignment NPD
• Equilibria Counseling, LLC

  • Clinical Social Worker
  • Salem, MA
  • NPI 1679437164
  NPD Authorized official
• Community Services Institute, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Springfield, MA
  • NPI 1255450631
  NPD
• Optum Behavioral Care of Connecticut, P.C.

  • Clinical Social Worker
  • Providence, RI
  • NPI 1730972944
  NPD
• Community Services Institute

  • Community/Behavioral Health Agency
  • Dorchester, MA
  • NPI 1114452828
  NPD (past)

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

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1215535604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE STE 84",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393071",
            "telephone_number": "802-500-2862",
            "fax_number": "617-354-4452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE STE 84",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393071",
            "telephone_number": "802-500-2862",
            "fax_number": "617-354-4452"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Washington St Ste 206",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021245538",
            "country_code": "US",
            "telephone_number": "617-325-2993",
            "fax_number": "617-325-5618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON-BAHOUN",
        "first_name": "TELE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-16",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "128563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Helene Williams, CCC-SLP
• Tyrone Jamar Williams, M.D.
• Emily Williamson, LCSW
• Willow Path Counseling, a Professional Clinical Counselor Corporation
• Emily K Wilner, PSYD
• Eileen A Wilson
• Ellen F Wilson, PH.D.
• Kelly R Wilson, PH.D.
• Loren Jay Wilson, DMD
• Lucy Wilson, RN

• Clinical Social Worker in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.