Wildflower Therapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WILDFLOWER THERAPY LLC

Practice address

57 S Main St
Waterbury, VT 05676-1557

Phone

(978) 831-3196

NPI assigned

May 28, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Jacqueline Shea Goodall, LICSWNPI 1801256730

Title

Owner/Clinician

Phone

(978) 831-3196

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacqueline Shea Goodall, LICSW

  • Clinical Social Worker
  • Burlington, VT
  • NPI 1801256730
  NPD Authorized official

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

{
    "created_epoch": "1716854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1275373391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 FAIRGROUND RD",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056768903",
            "telephone_number": "978-831-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 S MAIN ST",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761557",
            "telephone_number": "978-831-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDFLOWER THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-28",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "GOODALL",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "SHEA",
        "authorized_official_title_or_position": "OWNER/CLINICIAN",
        "authorized_official_telephone_number": "978-831-3196",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Clinical Social Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.