Active NPI
Shannon Kathleen Wiedenman
- Social Worker
- Chelsea, MA
National Provider Identifier
1649384215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 213356
- Practice address
- 301 Broadway
Chelsea, MA 02150-2807 - Phone
- (617) 912-7972
- NPI assigned
- Aug 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 213356 | MA | Primary |
Addresses
Primary practice location
301 Broadway
Chelsea, MA 02150-2807
Mailing address
7 Wyatt St
Somerville, MA 02143-3917
Phone (671) 767-1834
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213356 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649384215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 WYATT ST",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021433917",
"telephone_number": "671-767-1834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 BROADWAY",
"city": "CHELSEA",
"state": "MA",
"postal_code": "021502807",
"telephone_number": "617-912-7972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDENMAN",
"first_name": "SHANNON",
"middle_name": "KATHLEEN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "213356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chelsea, MA
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.