Active NPI
Georgia Anne Wimberly, LCSW
- Clinical Social Worker
- Endicott, NY
National Provider Identifier
1275853442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 081916
- Practice address
- 1200 E Main St
Endicott, NY 13760-5220 - Phone
- (607) 757-2171
- Fax
- (607) 757-2535
- NPI assigned
- Jun 10, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 061784-1 | NY | |
| Clinical Social Worker | 1041C0700X | 081916 | NY | Primary |
| School Social Worker | 1041S0200X | 162135071 | NY |
Addresses
Primary practice location
1200 E Main St
Endicott, NY 13760-5220
Mailing address
1200 E Main St
Endicott, NY 13760-5220
Phone (607) 757-2171
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 |
|---|---|---|---|
| 061784-1 | NY | MD | Social Worker |
| 081916 | NY | MD | Clinical Social Worker |
| 162135071 | NY | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402012800000",
"number": "1275853442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 E MAIN ST",
"city": "ENDICOTT",
"state": "NY",
"postal_code": "137605220",
"telephone_number": "607-757-2171",
"fax_number": "607-757-2535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 E MAIN ST",
"city": "ENDICOTT",
"state": "NY",
"postal_code": "137605220",
"telephone_number": "607-757-2171",
"fax_number": "607-757-2535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIMBERLY",
"first_name": "GEORGIA",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-10",
"last_updated": "2014-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "061784-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "081916",
"primary": true
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "NY",
"license": "162135071",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Endicott, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.