Individual provider Active NPI

Sephiratu Raji Wahab, PH.D.,LMSW

  • Clinical Social Worker
  • Syracuse, NY
National Provider Identifier
1437736410
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
092179-01 Issued in NY
Practice address
620 Madison St
Syracuse, NY 13210-2338
Phone
(315) 426-7740
NPI assigned
Mar 25, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2025

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 092179-01 NY Primary

Addresses

Primary practice location

620 Madison St
Syracuse, NY 13210-2338

Mailing address

4984 Woodmark Dr
Liverpool, NY 13088-3653

Other practice location 1

719 Harrison St
Syracuse, NY 13210-2695
Phone (315) 464-3265

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20211122001063 NY Practitioner - Clinical Social Worker 4688063084 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
092179NYMDSocial Worker
092179-01NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Faculty Practice, Inc. CurrentSince Dec 15, 2025 Accepting new patients

Locations

719 Harrison St
Syracuse, NY 13210
Phone (315) 464-3265

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1437736410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4984 WOODMARK DR",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 MADISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102338",
            "telephone_number": "315-426-7740"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "719 Harrison St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132102695",
            "country_code": "US",
            "telephone_number": "315-464-3265",
            "fax_number": "315-464-3282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHAB",
        "first_name": "SEPHIRATU",
        "middle_name": "RAJI",
        "credential": "PH.D.,LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-25",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "092179-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.