Brenda Gail Wise, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

PC007958 Issued in PA

Practice address

355 Burn Hill Rd
Shermans Dale, PA 17090-8905

Phone

(315) 286-6569

NPI assigned

Feb 19, 2020

Last updated

Feb 23, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Mental Health Counselor

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Integrated Wellness Management Inc

  • Mental Health Counselor
  • Worcester, MA
  • NPI 1508214545

  PA

  Medicare reassignment NPD

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1558994483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BURN HILL RD",
            "city": "SHERMANS DALE",
            "state": "PA",
            "postal_code": "170908905",
            "telephone_number": "315-286-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BURN HILL RD",
            "city": "SHERMANS DALE",
            "state": "PA",
            "postal_code": "170908905",
            "telephone_number": "315-286-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "BRENDA",
        "middle_name": "GAIL",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-19",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "PA",
            "license": "PC007958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shermans Dale Ambulance Associates
• Parth Upendra Tejani
• Betty Toms, BSC, PHARM.D
• Lori Carol Trostle, M.D.
• Jessica Danielle Wilson, COTA/L
• Catherine Ann Young, CCC/A
• Mario Zuccaroli, PHARMACIST

• Counselor in Shermans Dale, PA
• Providers in Shermans Dale, PA by specialty
• Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; 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.