Wanda Ramona Boutte

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

5241 Medea Way
Antioch, CA 94531-8727

Phone

(510) 469-1136

NPI assigned

Jun 2, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Wanda Ramona Boutte Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1370131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1376980227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5241 MEDEA WAY",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945318727",
            "telephone_number": "510-469-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5241 MEDEA WAY",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945318727",
            "telephone_number": "510-469-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTTE",
        "first_name": "WANDA",
        "middle_name": "RAMONA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-02",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "CA",
            "license": "293646",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES",
            "identifier": "1376980227",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN MEDICARE",
            "identifier": "CA206171",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "BOUTTE",
            "middle_name": "RAMONA",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brezelene Borca
• Tara Ann Borozzi
• Maria X. Borquez, MD
• Kristin N Boswell
• Mari L Bourret
• Mark Elliot Bovenkerk
• Estella Bowlsby
• Ajae Boyd
• George Edward Boyd, RPH
• Adeline A Boye, PSY.D

• Clinical Social Worker in Antioch, CA
• Providers in Antioch, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; 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.