Active NPI
Andrew Joseph Woolwine, EDS
- School Psychologist
- Clarksburg, WV
National Provider Identifier
1316222011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 9869
- Practice address
- 1201 N 15TH St
Clarksburg, WV 26301-1989 - Phone
- (304) 624-6554
- Fax
- (304) 624-5223
- NPI assigned
- Oct 14, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 9869 | WV | Primary |
Addresses
Primary practice location
1201 N 15TH St
Clarksburg, WV 26301-1989
Mailing address
239 Court Ave
Weston, WV 26452-2099
Phone (304) 624-6554
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810021612 | Medicaid | WV |
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 |
|---|---|---|---|
| 9869 | WV | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lewis County Board of Education | Past | Accepting new patients | |
| Lewis County Board of Education | 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.
-
- Local Education Agency (LEA)
- Weston, WV
- NPI 1336318211
-
- Local Education Agency (LEA)
- Weston, WV
- NPI 1801072467
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320796800000",
"number": "1316222011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 COURT AVE",
"city": "WESTON",
"state": "WV",
"postal_code": "264522099",
"telephone_number": "304-624-6554",
"fax_number": "304-624-5223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 N 15TH ST",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263011989",
"telephone_number": "304-624-6554",
"fax_number": "304-624-5223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOLWINE",
"first_name": "ANDREW",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "EDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-14",
"last_updated": "2011-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "WV",
"license": "9869",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810021612",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.