NPIMap

Individual provider Active NPI

Wilhelmena Victoria Vandenburg, LCSW-C

  • Clinical Social Worker
  • Baltimore, MD
National Provider Identifier
1316296270
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10361 Issued in MD
Practice address
1414 Key Hwy Ste 204
Baltimore, MD 21230-5189
Phone
(410) 790-4833
NPI assigned
Sep 6, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 10361 MD Primary

Addresses

Primary practice location

1414 Key Hwy Ste 204
Baltimore, MD 21230-5189

Mailing address

1344 W 41St St
Baltimore, MD 21211-1549
Phone (410) 790-4833

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL vicki.corozoncenter@aol.com Direct
CONNECT URL Baltimore Direct Corozon Center

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

LicenseStateTypeSpecialty
10361MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Corozon Center Clinical Past Accepting new patients
Smith Therapy, LLC Clinical Past Accepting new patients
Soul-Renity, LLC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1316296270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1344 W 41ST ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111549",
            "telephone_number": "410-790-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 KEY HWY STE 204",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212305189",
            "telephone_number": "410-790-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBURG",
        "first_name": "WILHELMENA",
        "middle_name": "VICTORIA",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-06",
        "last_updated": "2023-11-27",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "10361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "vicki.corozoncenter@aol.com",
            "affiliation": "Y",
            "endpointDescription": "LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "LLC",
            "address_1": "1414 Key Hwy Ste 204",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212305189",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Baltimore",
            "affiliation": "Y",
            "endpointDescription": "Corozon Center, LLC",
            "affiliationName": "Corozon Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "NPI 2",
            "address_1": "1414 Key Hwy Ste 204",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212305189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.