Stephanie Provost Wladkowski, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

114675 Issued in MA

Practice address

2 Hood St
Nahant, MA 01908-1432

Phone

(860) 794-6319

NPI assigned

Aug 6, 2008

Last updated

Sep 17, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Newton-Wellesley Behavioral Medicine & Eating Disorders

  • Clinical Psychologist
  • Brookline, MA
  • NPI 1891725792
  NPD (past)
• Newton-Wellesley Eating Disorders & Behavioral Medicine

  • Clinical Psychologist
  • Brookline, MA
  • NPI 1053389007
  NPD (past)

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1265698575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 HOOD ST",
            "city": "NAHANT",
            "state": "MA",
            "postal_code": "019081432",
            "telephone_number": "860-794-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 HOOD ST",
            "city": "NAHANT",
            "state": "MA",
            "postal_code": "019081432",
            "telephone_number": "860-794-6319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WLADKOWSKI",
        "first_name": "STEPHANIE",
        "middle_name": "PROVOST",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-06",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "114675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Lynn Sanphy, R.N, B.S.N
• Jennifer Kate Smith, PA-C
• Town of Nahant
• Town of Nahant
• Wellesley Healthcare Solutions LLC (Jesmond Nursing Home)

• Clinical Social Worker in Nahant, MA
• Providers in Nahant, 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 Sep 17, 2013; 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.