Individual provider Active NPI

Mary Elizabeth Wilson Eaton, LCSW

  • Clinical Social Worker
  • College Station, TX
National Provider Identifier
1396085809
Registry record updated Feb 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
51884 Issued in TX
Practice address
2700 Earl Rudder Fwy S Ste 5800
College Station, TX 77845-5010
Phone
(979) 398-6400
NPI assigned
Feb 20, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 51884 TX Primary

Addresses

Primary practice location

2700 Earl Rudder Fwy S Ste 5800
College Station, TX 77845-5010

Mailing address

2700 Earl Rudder Fwy S Ste 5800
College Station, TX 77845-5010

Other practice location 1

207 Rock Prairie Rd Ste A
College Station, TX 77845-8777
Phone (979) 229-7636

Other names 1

  • Ms. Mary Elizabeth Wilson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131114000309 TX Practitioner - Clinical Social Worker 6406082874 Practice locations: College Station, TX

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

207 Rock Prairie Rd
Suite a
College Station, TX 77845-8777
Phone (979) 398-6644

2700 Earl Rudder Fwy S
Suite 5800
College Station, TX 77845-5010
Phone (936) 295-3600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
51884TXMDMedical license number

NPI Registry JSON

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1396085809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 EARL RUDDER FWY S STE 5800",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778455010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 EARL RUDDER FWY S STE 5800",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778455010",
            "telephone_number": "979-398-6400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "207 Rock Prairie Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "College Station",
            "state": "TX",
            "postal_code": "778458777",
            "country_code": "US",
            "telephone_number": "979-229-7636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EATON",
        "first_name": "MARY ELIZABETH",
        "middle_name": "WILSON",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-20",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "51884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WILSON",
            "middle_name": "ELIZABETH",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in College Station, TX

Sources for this page

Verify at the official NPI Registry.