NPIMap

Organization Active NPI

Wanderlust Therapeutic Services, PLLC

  • Clinical Social Worker
  • Nashua, NH
National Provider Identifier
1225659600
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
WANDERLUST THERAPEUTIC SERVICES, PLLC
Practice address
400 Amherst St Ste 200
Nashua, NH 03063-4223
Phone
(603) 889-3553
Fax
(603) 589-4981
NPI assigned
Apr 27, 2020
Last updated
Aug 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Authorized official

Name
Melbourne Richard Moran Jr., LICSWNPI 1871997379
Title
Proprietor
Phone
(978) 483-0182

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

400 Amherst St Ste 200
Nashua, NH 03063-4223

Mailing address

400 Amherst St Ste 200
Nashua, NH 03063-4223
Phone (603) 889-3553

Other practice location 1

60 Fletcher St Ste 201
Lowell, MA 01854-4312
Phone (603) 889-3553

Other practice location 2

889 Elm St Fl 5
Manchester, NH 03101-2019
Phone (603) 889-3553

Other practice location 3

312 SE Stonemill Dr Ste 135
Vancouver, WA 98684-3508
Phone (603) 889-3553

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address lisa@wanderlustservices.org Direct
CONNECT URL admin@wanderlustservices.org
Direct Messaging Address lisa@wanderlustservices.org Direct
Direct Messaging Address lisa@wanderlustservices.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA, WA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20210210002846 NH Part B Supplier - Clinic/Group Practice 7012322753 Receives reassigned benefits from 14 practitioners
Practice locations: Manchester, NH; Nashua, NH
O20230103000717 MA Part B Supplier - Clinic/Group Practice 7012322753 Receives reassigned benefits from 5 practitioners
Practice locations: Lowell, MA
O20240821000934 WA Part B Supplier - Clinic/Group Practice 7012322753 Receives reassigned benefits from 2 practitioners
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Locations

60 Fletcher St
Ste 201
Lowell, MA 01854
Phone (603) 889-3553

97 Central St
Ste 205A
Lowell, MA 01852

97 Central St
Ste 300
Lowell, MA 01852
Phone (603) 889-3553

889 Elm St
Manchester, NH 03101
Phone (603) 889-3553

889 Elm St
Fl 5
Manchester, NH 03101
Phone (603) 889-3553

400 Amherst St
Ste 200
Nashua, NH 03063
Phone (603) 205-3623

71 Spit Brook Rd
Ste 407
Nashua, NH 03060
Phone (603) 589-9805

312 SE Stonemill Dr
Ste 135
Vancouver, WA 98684
Phone (360) 356-1114

Interoperability endpoints

  • Direct secure messaging: lisa@wanderlustservices.org

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1587945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1225659600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AMHERST ST STE 200",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030634223",
            "telephone_number": "603-889-3553",
            "fax_number": "603-589-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AMHERST ST STE 200",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030634223",
            "telephone_number": "603-889-3553",
            "fax_number": "603-589-4981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 Fletcher St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Lowell",
            "state": "MA",
            "postal_code": "018544312",
            "country_code": "US",
            "telephone_number": "603-889-3553",
            "fax_number": "603-589-4981",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "889 Elm St Fl 5",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "NH",
            "postal_code": "031012019",
            "country_code": "US",
            "telephone_number": "603-889-3553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "312 SE Stonemill Dr Ste 135",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986843508",
            "country_code": "US",
            "telephone_number": "603-889-3553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WANDERLUST THERAPEUTIC SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-27",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "MELBOURNE",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "978-483-0182",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa@wanderlustservices.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "97 Central St Ste 205A",
            "city": "Lowell",
            "state": "MA",
            "country_code": "US",
            "postal_code": "018521943",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "admin@wanderlustservices.org",
            "affiliation": "N",
            "address_1": "71 Spit Brook Rd Ste 407",
            "city": "Nashua",
            "state": "NH",
            "country_code": "US",
            "postal_code": "030605636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa@wanderlustservices.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "97 Central St Ste 205A",
            "city": "Lowell",
            "state": "MA",
            "country_code": "US",
            "postal_code": "018521943",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa@wanderlustservices.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "97 Central St Ste 205A",
            "city": "Lowell",
            "state": "MA",
            "country_code": "US",
            "postal_code": "018521943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Nashua, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.