Active NPI
Tamara W. Wynn
- Clinical Social Worker
- Lakewood, OH
National Provider Identifier
1275803975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I0002521
- Practice address
- 14650 Detroit Avenue
Suite LL40
Lakewood, OH 44107 - Phone
- (216) 226-2721
- Fax
- (216) 226-2731
- NPI assigned
- Jan 11, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 071041 | OH | |
| Clinical Social Worker | 1041C0700X | I0002521 | OH | Primary |
Addresses
Primary practice location
14650 Detroit Avenue
Suite LL40
Lakewood, OH 44107
Mailing address
14650 Detroit Avenue
Suite LL40
Lakewood, OH 44107
Phone (216) 226-2721
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071041 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| I0002521 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1275803975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14650 DETROIT AVENUE",
"address_2": "SUITE LL40",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "44107",
"telephone_number": "216-226-2721",
"fax_number": "216-226-2731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14650 DETROIT AVENUE",
"address_2": "SUITE LL40",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "44107",
"telephone_number": "216-226-2721",
"fax_number": "216-226-2731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNN",
"first_name": "TAMARA",
"middle_name": "W.",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-11",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "071041",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I0002521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.