Active NPI
Russell Jeremy Gwilliam, MA, LMHC
- Community/Behavioral Health Agency
- Worcester, MA
National Provider Identifier
1346557543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- 1745
- Practice address
- 44 Front St
Worcester, MA 01608-1733 - Phone
- (508) 753-0321
- NPI assigned
- Sep 9, 2010
- 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 |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 1745 | MA | Primary |
Addresses
Primary practice location
44 Front St
Worcester, MA 01608-1733
Mailing address
12 Pineview TRL
Auburn, MA 01501-2120
Phone (508) 864-0839
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1745 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283990400000",
"number": "1346557543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 PINEVIEW TRL",
"city": "AUBURN",
"state": "MA",
"postal_code": "015012120",
"telephone_number": "508-864-0839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 FRONT ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016081733",
"telephone_number": "508-753-0321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWILLIAM",
"first_name": "RUSSELL",
"middle_name": "JEREMY",
"credential": "MA, LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-09",
"last_updated": "2010-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "MA",
"license": "1745",
"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 Sep 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.