Gwendolyn Wayne, LCSW, CMTPT, LMT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8668 Issued in CT

Practice address

17 Old Hickory LN
Branford, CT 06405-2827

Phone

(203) 488-6411

NPI assigned

Sep 12, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Specialty

Clinical Social Worker

Education

Fordham University School of Medicine, 2010

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425859200000",
    "number": "1558796201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 515",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064050515",
            "telephone_number": "203-488-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 OLD HICKORY LN",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064052827",
            "telephone_number": "203-488-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAYNE",
        "first_name": "GWENDOLYN",
        "credential": "LCSW, CMTPT, LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-12",
        "last_updated": "2015-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "CT",
            "license": "000394",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "8668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Walsh, MA, LPC
• Natalie Walters, APRN
• Gary R Wanerka, M.D.
• Stephen Waters, R.PH., PH.D.
• Waterside Behavioral Health, LLC
• Waypoint Counseling and Psychotherapy, LLC
• Franchesca Wedderburn, LCSW
• Jordan Welch
• Belinda J Westerlund
• Laura Westphal, RPH

• Clinical Social Worker in Branford, CT
• Providers in Branford, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.