NPIMap

Individual provider Active NPI

Mary Wyatt, MA

  • Social Worker
  • Espanola, NM
National Provider Identifier
1700184132
Registry record updated Mar 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
X-07090 Issued in NM
Practice address
404 Hunter St
Espanola, NM 87532-2655
Phone
(505) 753-4123
Fax
(505) 753-6947
NPI assigned
Mar 9, 2011
Last updated
Mar 9, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X X-07090 NM Primary

Addresses

Primary practice location

404 Hunter St
Espanola, NM 87532-2655

Mailing address

404 Hunter St
Espanola, NM 87532-2655
Phone (505) 753-4123

Other identifiers 1

IdentifierTypeStateIssuer
E7436MedicaidNM

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
X-07090NMMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Las Cumbres Community Services Past Accepting new patients
Las Cumbres Community Services Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299628800000",
    "number": "1700184132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 HUNTER ST",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322655",
            "telephone_number": "505-753-4123",
            "fax_number": "505-753-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 HUNTER ST",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322655",
            "telephone_number": "505-753-4123",
            "fax_number": "505-753-6947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "MARY",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-09",
        "last_updated": "2011-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "X-07090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E7436",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Espanola, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; 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.