Active NPI
Wendy McDonald, LICSW
- Clinical Social Worker
- Brockton, MA
National Provider Identifier
1255401188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 112101
- Practice address
- VA Boston Healthcare System
940 Belmont Street
Brockton, MA 02301 - Phone
- (774) 826-3694
- NPI assigned
- Nov 8, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | |||
| School Social Worker | 1041S0200X | |||
| Clinical Social Worker | 1041C0700X | 112101 | MA | Primary |
Addresses
Primary practice location
VA Boston Healthcare System
940 Belmont Street
Brockton, MA 02301
Mailing address
18 Bradley Dr Unit D
Groton, MA 01450-4302
Phone (978) 339-9153
Other practice location 1
100 Linden St
Holliston, MA 01746-1803
Phone (508) 429-0620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112101 | Other | MA | COMMONWEALTH OF MA, DIVISION OF PROFESSIONAL LICENSURE, BOARD OF SOCIAL WORKERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112101 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601596800000",
"number": "1255401188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 BRADLEY DR UNIT D",
"city": "GROTON",
"state": "MA",
"postal_code": "014504302",
"telephone_number": "978-339-9153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "VA BOSTON HEALTHCARE SYSTEM",
"address_2": "940 BELMONT STREET",
"city": "BROCKTON",
"state": "MA",
"postal_code": "02301",
"telephone_number": "774-826-3694"
}
],
"practiceLocations": [
{
"address_1": "100 Linden St",
"address_purpose": "LOCATION",
"city": "Holliston",
"state": "MA",
"postal_code": "017461803",
"country_code": "US",
"telephone_number": "508-429-0620",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCDONALD",
"first_name": "WENDY",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2020-10-02",
"certification_date": "2020-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "112101",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMONWEALTH OF MA, DIVISION OF PROFESSIONAL LICENSURE, BOARD OF SOCIAL WORKERS",
"identifier": "112101",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.