Jodie C Wilson, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

079038 Issued in NY

Practice address

407 Tulip Street
Liverpool, NY 13088-4962

Phone

(315) 657-3111

Fax

(315) 451-5557

NPI assigned

Feb 19, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2017 through Apr 1, 2027

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1366610735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 TULIP ST",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130884962",
            "telephone_number": "315-657-3111",
            "fax_number": "315-451-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 TULIP STREET",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130884962",
            "telephone_number": "315-657-3111",
            "fax_number": "315-451-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JODIE",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-19",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "079038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Triush Tence Williams, LPN
• Robert Douglas Willis, D.D.S.
• Brooke Wills-Thomas, BCBA
• Erika Wilsch, MS. CCC-SLP
• Jillian Wilson, MA,RD
• M. Daveda Wingenbach, PT
• Ashleigh B Wingood
• Jennifer Wingood, PHARMD
• Savannah Raine Winks
• Tina Winter, NP

• Clinical Social Worker in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.