Jan Emily Wiley-Egdall, MSW ,LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LICSW103621 Issued in MA

Practice address

1140 Dorchester Ave
Dorchester, MA 02125-3305

Phone

(617) 288-0907

Fax

(617) 474-0757

NPI assigned

May 31, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Upham'S Corner Health Committee, Inc.

  • PACE Provider Organization
  • Dorchester, MA
  • NPI 1316023195
  NPD (past)

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811198112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 BROOKVALE ST",
            "address_2": "APARTMENT 2",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021244810",
            "telephone_number": "617-296-1238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 DORCHESTER AVE",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021253305",
            "telephone_number": "617-288-0907",
            "fax_number": "617-474-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY-EGDALL",
        "first_name": "JAN",
        "middle_name": "EMILY",
        "name_prefix": "Mrs.",
        "credential": "MSW ,LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW103621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robyn Nicole White, PHARMD
• Jean Suzin Whitten, MD
• Mitchell Wiegand
• Kama Wien
• Kate Wilcox
• William Lee DDS & June Warren Lee DDS
• Amber A Williams
• Jazzmine Williams
• Jendayi Williams
• Latarsha Williams

• Clinical Social Worker in Dorchester, MA
• Providers in Dorchester, MA by specialty
• Clinical Social Worker in Massachusetts

• 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.

Verify at the official NPI Registry.