Active NPI
Deserie Aline Clack-Wilson
- Community Health Worker
- Bridgeport, CT
National Provider Identifier
1447869029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 1000 Lafayette Blvd Ste 1128
Bridgeport, CT 06604-4725 - Phone
- (203) 683-3428
- Fax
- (203) 683-5901
- NPI assigned
- Jul 29, 2020
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | CT | Primary |
Addresses
Primary practice location
1000 Lafayette Blvd Ste 1128
Bridgeport, CT 06604-4725
Mailing address
1000 Lafayette Blvd Ste 1128
Bridgeport, CT 06604-4725
Phone (203) 683-3428
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | url | Health Information Exchange (HIE) | |
| Other URL | url | Health Information Exchange (HIE) |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595980800000",
"number": "1447869029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 LAFAYETTE BLVD STE 1128",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066044725",
"telephone_number": "203-683-3428",
"fax_number": "203-683-5901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 LAFAYETTE BLVD STE 1128",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066044725",
"telephone_number": "203-683-3428",
"fax_number": "203-683-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLACK-WILSON",
"first_name": "DESERIE",
"middle_name": "ALINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-29",
"last_updated": "2020-07-29",
"certification_date": "2020-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CT",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "url",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1000 Lafayette Blvd Ste 1128",
"city": "Bridgeport",
"state": "CT",
"country_code": "US",
"postal_code": "066044725",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "url",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1000 Lafayette Blvd Ste 1128",
"city": "Bridgeport",
"state": "CT",
"country_code": "US",
"postal_code": "066044725",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bridgeport, CT
- City of Bridgeport Health Dept. School Based Health Center
- City of Bridgeport Health Dept. School Based Health Center
- City of Bridgeport Health Dept. School Based Health Center
- City of Bridgeport Health Dept. School Based Health Centers
- Anna Maria Clabby, APRN
- Claire Zang, Psychotherapist, LCSW, LLC
- Nicole Clairmont, LPC
- John-Ross David Rolphe Clarke, M.D.
- Lana Clement, CRNA
- Clinical Love and Care
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.