Active NPI
Marlene Wacks
- Speech-Language Pathologist
- Worcester, MA
National Provider Identifier
1306125356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8302
- Practice address
- 484 Main St
Easter Seals Massachusetts
Worcester, MA 01608-1893 - Phone
- (800) 244-2756
- NPI assigned
- Aug 9, 2011
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 8302 | MA | Primary |
Addresses
Primary practice location
484 Main St
Easter Seals Massachusetts
Worcester, MA 01608-1893
Mailing address
72 Euston Rd
#109
Brighton, MA 02135-4143
Phone (401) 374-5625
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 |
|---|---|---|---|
| 8302 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1306125356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 EUSTON RD",
"address_2": "#109",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "021354143",
"telephone_number": "401-374-5625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "484 MAIN ST",
"address_2": "EASTER SEALS MASSACHUSETTS",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016081893",
"telephone_number": "800-244-2756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACKS",
"first_name": "MARLENE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-09",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "8302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.