Kyle Wyman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW022109 Issued in PA

Practice address

3900 Woodland Ave
Philadelphia, PA 19104-4551

Phone

(215) 594-1445

NPI assigned

Aug 20, 2018

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1265912299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044551",
            "telephone_number": "215-594-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044551",
            "telephone_number": "215-594-1445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "KYLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-20",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW022109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Megan Wyckoff, MD
• Wycombe Pharmacy Inc.
• Justin Joseph Wyda, MD
• Gerald Charles Wydro, MD
• David A Wyler, MD
• Matthew Blaine Wyman, LPC
• Kerry Mart Wymbs, C.P.N.P.
• Wyndmoor Rehab Associates P.C.
• Wyngate Primary Are LLC
• Wynn Transit LLC

• Clinical Social Worker in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.