Active NPI
Mary Ann Wildwood, LCSW
- Social Worker
- Energy, IL
National Provider Identifier
1295780377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 149005571
- Practice address
- 202 S. Pershing St.
Goya Health LTD.
Energy, IL 62933 - Phone
- (618) 988-9843
- Fax
- (618) 942-8640
- NPI assigned
- May 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 149005571 | IL | Primary |
Addresses
Primary practice location
202 S. Pershing St.
Goya Health LTD.
Energy, IL 62933
Mailing address
P.O. Box 100
Goya Health LTD.
Energy, IL 62933
Phone (618) 988-9843
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 800012395 | Other | IL | RR MEDICARE |
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 |
|---|---|---|---|
| 149005571 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holistic Psychiatry Inc | Past | Accepting new patients | |
| Wolz Health, Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adolescent and Children Mental Health Clinic/Center
- Energy, IL
- NPI 1285906198
-
- Psychiatry Physician
- Carbondale, IL
- NPI 1619062478
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1295780377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 100",
"address_2": "GOYA HEALTH LTD.",
"city": "ENERGY",
"state": "IL",
"postal_code": "62933",
"telephone_number": "618-988-9843",
"fax_number": "618-942-8640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 S. PERSHING ST.",
"address_2": "GOYA HEALTH LTD.",
"city": "ENERGY",
"state": "IL",
"postal_code": "62933",
"telephone_number": "618-988-9843",
"fax_number": "618-942-8640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDWOOD",
"first_name": "MARY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-24",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "149005571",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "800012395",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Energy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.