Active NPI
Breanna Wardwell
- Developmental Therapist
- Springfield, MA
National Provider Identifier
1508351107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 110 Maple St Ste 110
Springfield, MA 01105 - Phone
- (413) 732-7419
- NPI assigned
- Jun 26, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | |||
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
110 Maple St Ste 110
Springfield, MA 01105
Mailing address
345 Greenwood St Ste a
Worcester, MA 01607-1767
Other practice location 1
345 Greenwood St Ste A
Worcester, MA 01607-1767
Phone (508) 363-0200
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": "1529971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533945600000",
"number": "1508351107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 GREENWOOD ST STE A",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016071767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 MAPLE ST STE 110",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "01105",
"telephone_number": "413-732-7419"
}
],
"practiceLocations": [
{
"address_1": "345 Greenwood St Ste A",
"address_purpose": "LOCATION",
"city": "Worcester",
"state": "MA",
"postal_code": "016071767",
"country_code": "US",
"telephone_number": "508-363-0200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WARDWELL",
"first_name": "BREANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-26",
"last_updated": "2018-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.