Active NPI
Mary Wiklacz, LISW-CP
- Clinical Social Worker
- Greenville, SC
National Provider Identifier
1679778369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 8645
- Practice address
- 7 Pettigru St
Greenville, SC 29601-3000 - Phone
- (864) 235-7501
- Fax
- (864) 235-7503
- NPI assigned
- Jun 20, 2007
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 8645 | SC | Primary |
Addresses
Primary practice location
7 Pettigru St
Greenville, SC 29601-3000
Mailing address
116 Crown Empire CT
Simpsonville, SC 29681-6354
Phone (864) 289-0043
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
| License | State | Type | Specialty |
|---|---|---|---|
| 8645 | SC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679778369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 CROWN EMPIRE CT",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296816354",
"telephone_number": "864-289-0043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 PETTIGRU ST",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296013000",
"telephone_number": "864-235-7501",
"fax_number": "864-235-7503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIKLACZ",
"first_name": "MARY",
"credential": "LISW-CP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "SC",
"license": "8645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
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.