Emily Wickman

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4680 Issued in CT

Practice address

22 Belle Vista HTS
Portland, CT 06480-1672

Phone

(860) 997-6679

NPI assigned

Jan 11, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Psychological Health and Development Associates LLCGroup PAC ID 6103129333, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Psychological Health & Development Associates, LLC

  • Psychologist
  • Wethersfield, CT
  • NPI 1144519968
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1641859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1740931856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BELLE VISTA HTS",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BELLE VISTA HTS",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801672",
            "telephone_number": "860-997-6679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKMAN",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "4680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Tynan, LMT
• Walgreen Co
• Katelyn Mary Warner, LPC
• Waterview Dental Group, LLC
• Deborah D Webster, P.T.
• Kristen Johanna Mary Wils, MD
• Edward Paul Wysocki Jr., D.M.D.
• Leigh Suzanne Young, LPN
• Michael Zemaitis, PHARMD

• Clinical Social Worker in Portland, CT
• Providers in Portland, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.