Active NPI
Patricia A Wallender, LICSW
- Clinical Social Worker
- Pittsfield, MA
National Provider Identifier
1497813752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 106585
- Practice address
- 34 Depot St Suite 201
Couseling Center in the Berkshires
Pittsfield, MA 01201 - Phone
- (413) 499-4090
- Fax
- (413) 499-1844
- NPI assigned
- Dec 5, 2006
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 106585 | MA | Primary |
Addresses
Primary practice location
34 Depot St Suite 201
Couseling Center in the Berkshires
Pittsfield, MA 01201
Mailing address
34 Depot St Suite 201
Couseling Center in the Berkshires
Pittsfield, MA 01201
Phone (413) 499-4090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 667870 | Other | MA | TUFTS MA |
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 |
|---|---|---|---|
| 106585 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497813752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 DEPOT ST SUITE 201",
"address_2": "COUSELING CENTER IN THE BERKSHIRES",
"city": "PITTSFIELD",
"state": "MA",
"postal_code": "01201",
"telephone_number": "413-499-4090",
"fax_number": "413-499-1844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 DEPOT ST SUITE 201",
"address_2": "COUSELING CENTER IN THE BERKSHIRES",
"city": "PITTSFIELD",
"state": "MA",
"postal_code": "01201",
"telephone_number": "413-499-4090",
"fax_number": "413-499-1844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLENDER",
"first_name": "PATRICIA",
"middle_name": "A",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "106585",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS MA",
"identifier": "667870",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittsfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.