Individual provider Active NPI

Laura D. Wiley, LCSW

  • Clinical Social Worker
  • Bangor, ME
National Provider Identifier
1548278989
Registry record updated Jun 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC6679 Issued in ME
Practice address
96 Harlow St
Suite 224
Bangor, ME 04401-4925
Phone
(207) 945-9754
NPI assigned
Aug 3, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2009

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 LC6679 ME Primary

Addresses

Primary practice location

96 Harlow St
Suite 224
Bangor, ME 04401-4925

Mailing address

96 Harlow St
Suite 224
Bangor, ME 04401-4925
Phone (207) 945-9754

Other identifiers 1

IdentifierTypeStateIssuer
31010099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20050627000889 ME Practitioner - Clinical Social Worker 0547205882 Practice locations: Bangor, ME

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

96 Harlow St
Suite 202
Bangor, ME 04401-4981
Phone (207) 945-9754

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LC6679MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Possibilities Counseling Services, Inc. Past Accepting new patients
Sweetser PastSince Mar 12, 2012 Accepting new patients

Organizations & group practices 2

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243987200000",
    "number": "1548278989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 HARLOW ST",
            "address_2": "SUITE 224",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014925",
            "telephone_number": "207-945-9754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 HARLOW ST",
            "address_2": "SUITE 224",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014925",
            "telephone_number": "207-945-9754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "LAURA",
        "middle_name": "D.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2009-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC6679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31010099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.