Active NPI
Evelyn Wilson, LMSW
- Social Worker
- Bronx, NY
National Provider Identifier
1376063248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 093620
- Practice address
- 1276 Fulton Ave RM 206
Bronx, NY 10456-3402 - Phone
- (718) 901-8918
- Fax
- (718) 901-8918
- NPI assigned
- Jun 22, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 093620 | NY | Primary |
Addresses
Primary practice location
1276 Fulton Ave RM 206
Bronx, NY 10456-3402
Mailing address
1276 Fulton Ave RM 206
Bronx, NY 10456-3402
Phone (718) 901-8918
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 093620 | Other | NY | DOH |
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 |
|---|---|---|---|
| 093620 | NY | MD | Clinical Social Worker |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498089600000",
"number": "1376063248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1276 FULTON AVE RM 206",
"city": "BRONX",
"state": "NY",
"postal_code": "104563402",
"telephone_number": "718-901-8918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1276 FULTON AVE RM 206",
"city": "BRONX",
"state": "NY",
"postal_code": "104563402",
"telephone_number": "718-901-8918",
"fax_number": "718-901-8918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "EVELYN",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-22",
"last_updated": "2017-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "093620",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DOH",
"identifier": "093620",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.