Theresa O Wilson, LISW-S, SAP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1000025-SUPV Issued in OH

Practice address

130 1St St NW
Massillon, OH 44647-5452

Phone

(330) 833-0234

Fax

(330) 837-7705

NPI assigned

Mar 2, 2012

Sex

Female

Sole proprietor

Yes

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 OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Coleman Professional Services, Inc.

  • Mental Health Counselor
  • Kent, OH
  • NPI 1982637633

  Clinical

  Medicare reassignment NPD
• Psycho Social Therapies,LTD

  • Clinical Social Worker
  • Beachwood, OH
  • NPI 1750335261
  NPD (past)
• Psycho Social Therapies,LTD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beachwood, OH
  • NPI 1902462906
  NPD (past)

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

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1821362286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 CLEVELAND AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021805",
            "telephone_number": "330-455-0374",
            "fax_number": "330-453-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 1ST ST NW",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446475452",
            "telephone_number": "330-833-0234",
            "fax_number": "330-837-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "THERESA",
        "middle_name": "O",
        "credential": "LISW-S, SAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-02",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1000025-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary G Willis
• Sarina Wills
• Lynne Ellen Wilson, CNP
• Nina Marie Wilson, CNM
• Reona Capri Wilson
• Brian E Wind, D.O.
• Kelley Sue Winland, DSP
• Elisabeth Ashley Wirth
• Withcare LLC
• Marina Lynn Wittensoldner, CNP

• Clinical Social Worker in Massillon, OH
• Providers in Massillon, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.