Circle of Life MD LLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

CIRCLE OF LIFE MD LLC

Practice address

203 Willow St BLDG B
South Hamilton, MA 01982-2292

Phone

(978) 535-6043

Fax

(978) 535-6047

NPI assigned

Jun 2, 2010

Last updated

Feb 16, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kirsten E Wagner, MD

Title

Owner-Director

Phone

(978) 468-2850

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1326368325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 WILLOW ST BLDG B",
            "city": "SOUTH HAMILTON",
            "state": "MA",
            "postal_code": "019822255",
            "telephone_number": "978-535-6043",
            "fax_number": "978-535-6047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 WILLOW ST BLDG B",
            "city": "SOUTH HAMILTON",
            "state": "MA",
            "postal_code": "019822292",
            "telephone_number": "978-535-6043",
            "fax_number": "978-535-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIRCLE OF LIFE MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-02",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER-DIRECTOR",
        "authorized_official_telephone_number": "978-468-2850",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "223761",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Walter B Clayton, M.D.
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• Maryellen Fairchild Collamore, LICSW, LCSW, MT-BC
• Sarah Coombs, OTR/L
• Courtney Cowan, APN

• Child & Adolescent Psychiatry Physician in South Hamilton, MA
• Providers in South Hamilton, MA by specialty
• Child & Adolescent Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.