NPIMap

Individual provider Active NPI

Jayne Wilson, LICSW

  • Clinical Social Worker
  • Woburn, MA
National Provider Identifier
1710125646
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1027382 Issued in MA
Practice address
3 Baldwin Green CMN
Suite 303
Woburn, MA 01801-1865
Phone
(781) 932-0257
Fax
(781) 932-6727
NPI assigned
Jan 30, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

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 1027382 MA Primary

Addresses

Primary practice location

3 Baldwin Green CMN
Suite 303
Woburn, MA 01801-1865

Mailing address

3 Baldwin Green CMN
Suite 303
Woburn, MA 01801-1865
Phone (781) 932-0257

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

LicenseStateTypeSpecialty
1027382MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Health Resources Inc Past Accepting new patients
Harbormed LLC 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233273600000",
    "number": "1710125646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BALDWIN GREEN CMN",
            "address_2": "SUITE 303",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011865",
            "telephone_number": "781-932-0257",
            "fax_number": "781-932-6727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BALDWIN GREEN CMN",
            "address_2": "SUITE 303",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011865",
            "telephone_number": "781-932-0257",
            "fax_number": "781-932-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JAYNE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2009-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1027382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; 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.