Active NPI
Michael E Wiley, LCSW
- Clinical Social Worker
- Caldwell, ID
National Provider Identifier
1396964839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-804
- Practice address
- 2805 Blaine St
Ste 120
Caldwell, ID 83605-4599 - Phone
- (208) 459-4412
- Fax
- (208) 454-7296
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-804 | ID | Primary |
Addresses
Primary practice location
2805 Blaine St
Ste 120
Caldwell, ID 83605-4599
Mailing address
5563 W Lucky Dr
Boise, ID 83703-3188
Phone (208) 724-9276
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-804 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299542400000",
"number": "1396964839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5563 W LUCKY DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837033188",
"telephone_number": "208-724-9276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 BLAINE ST",
"address_2": "STE 120",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836054599",
"telephone_number": "208-459-4412",
"fax_number": "208-454-7296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILEY",
"first_name": "MICHAEL",
"middle_name": "E",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2011-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Caldwell, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.