Active NPI
Maylene Vidro
- Clinical Social Worker
- Waterbury, CT
National Provider Identifier
1306463674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- MSW.5324
- Practice address
- 141 E Main St
Waterbury, CT 06702-2310 - Phone
- (203) 574-9000
- Fax
- (203) 574-9006
- NPI assigned
- Jul 2, 2020
- Last updated
- Oct 19, 2020
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Clinical Social Worker | 1041C0700X | MSW.5324 | CT | Primary |
Addresses
Primary practice location
141 E Main St
Waterbury, CT 06702-2310
Mailing address
141 E Main St
Waterbury, CT 06702-2310
Phone (203) 574-9000
Other practice location 1
2 Trap Falls Rd Ste 120
Shelton, CT 06484-7621
Phone (203) 816-6424
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 |
|---|---|---|---|
| MSW.5324 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Progressive Institute LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Shelton, CT
- NPI 1669944724
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603065600000",
"number": "1306463674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 E MAIN ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067022310",
"telephone_number": "203-574-9000",
"fax_number": "203-574-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 E MAIN ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067022310",
"telephone_number": "203-574-9000",
"fax_number": "203-574-9006"
}
],
"practiceLocations": [
{
"address_1": "2 Trap Falls Rd Ste 120",
"address_purpose": "LOCATION",
"city": "Shelton",
"state": "CT",
"postal_code": "064847621",
"country_code": "US",
"telephone_number": "203-816-6424",
"fax_number": "203-513-8474",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VIDRO",
"first_name": "MAYLENE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-02",
"last_updated": "2020-10-19",
"certification_date": "2020-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "MSW.5324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.