Individual provider Active NPI

Paula Wagman, LCSW

  • Clinical Social Worker
  • East Northport, NY
National Provider Identifier
1750521704
Registry record updated Mar 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R029072 Issued in NY
Practice address
2 Brian LN
East Northport, NY 11731-3808
Phone
(631) 266-1775
NPI assigned
Mar 4, 2009
Last updated
Mar 4, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 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 R029072 NY Primary

Addresses

Primary practice location

2 Brian LN
East Northport, NY 11731-3808

Mailing address

2 Brian LN
East Northport, NY 11731-3808
Phone (631) 266-1775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20170612002036 NY Practitioner - Clinical Social Worker 1254609456 Practice locations: East Northport, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
State University of New York at Stony Brook, School of Medicine, 1982
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2 Brian LN
East Northport, NY 11731-3808
Phone (631) 275-9446

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R029072NYMDClinical Social Worker
029072NYMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1236124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236124800000",
    "number": "1750521704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 BRIAN LN",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117313808",
            "telephone_number": "631-266-1775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BRIAN LN",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117313808",
            "telephone_number": "631-266-1775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGMAN",
        "first_name": "PAULA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-04",
        "last_updated": "2009-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R029072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Northport, NY

Sources for this page

Verify at the official NPI Registry.