Individual provider Active NPI

Patricia A Wieboldt, LCSW

  • Clinical Social Worker
  • Skillman, NJ
National Provider Identifier
1659410413
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC00386900 Issued in NJ
Practice address
43 Tamarack Circle
Skillman, NJ 08558
Phone
(908) 359-4670
NPI assigned
Feb 6, 2007
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 44SC00386900 NJ Primary

Addresses

Primary practice location

43 Tamarack Circle
Skillman, NJ 08558

Mailing address

23 Marian Drive
Belle Mead, NJ 08502
Phone (908) 359-4670

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
44SC00386900NJMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659410413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 MARIAN DRIVE",
            "city": "BELLE MEAD",
            "state": "NJ",
            "postal_code": "08502",
            "telephone_number": "908-359-4670",
            "fax_number": "908-237-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 TAMARACK CIRCLE",
            "city": "SKILLMAN",
            "state": "NJ",
            "postal_code": "08558",
            "telephone_number": "908-359-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEBOLDT",
        "first_name": "PATRICIA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC00386900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skillman, NJ

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.