Individual provider Active NPI

Catherine Cecilia Wilder, LCSW

  • Clinical Social Worker
  • Farmingville, NY
National Provider Identifier
1619043023
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
043731-1 Issued in NY
Practice address
15 Horseblock PL
Farmingville, NY 11738-1204
Phone
(631) 854-2571
Fax
(631) 854-2580
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 043731-1 NY Primary

Addresses

Primary practice location

15 Horseblock PL
Farmingville, NY 11738-1204

Mailing address

41 Vidoni Dr
Mount Sinai, NY 11766-1736
Phone (631) 473-6386

Other identifiers 3

IdentifierTypeStateIssuer
043731-1OtherNYLICENSE NUMBER
5613055OtherNYCERTIFICATE NUMBER
00354807MedicaidNY

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

LicenseStateTypeSpecialty
043731-1NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619043023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 VIDONI DR",
            "city": "MOUNT SINAI",
            "state": "NY",
            "postal_code": "117661736",
            "telephone_number": "631-473-6386",
            "fax_number": "631-854-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 HORSEBLOCK PL",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117381204",
            "telephone_number": "631-854-2571",
            "fax_number": "631-854-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "CATHERINE",
        "middle_name": "CECILIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "043731-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "043731-1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE NUMBER",
            "identifier": "5613055",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00354807",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmingville, NY

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.

Verify at the official NPI Registry.