Peggy Ilona Waller, LCSW, LCADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05457700 Issued in NJ

Practice address

80 W Main St
Mendham, NJ 07945-1257

Phone

(973) 543-5656

Fax

(973) 543-1361

NPI assigned

Jan 25, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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.

• Recover Together, LLC

  • Adult Mental Health Clinic/Center
  • Lawrenceburg, IN
  • NPI 1891102497

  VA

  Medicare reassignment NPD
• Recover Together, Inc.

  • Adult Mental Health Clinic/Center
  • London, KY
  • NPI 1346736758
  NPD

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327449600000",
    "number": "1821369562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 W MAIN ST",
            "city": "MENDHAM",
            "state": "NJ",
            "postal_code": "079451257",
            "telephone_number": "973-543-5656",
            "fax_number": "973-543-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 W MAIN ST",
            "city": "MENDHAM",
            "state": "NJ",
            "postal_code": "079451257",
            "telephone_number": "973-543-5656",
            "fax_number": "973-543-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "PEGGY",
        "middle_name": "ILONA",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LCADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-25",
        "last_updated": "2012-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00125500",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05457700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francesca Marie Viola
• Visiting Health Associates
• Michael F Vonpoelnitz, M.D.
• Christine Smith Wagner, OT
• Diamond Eri-C Walker
• Christian A Walsh
• Christopher Waters, LPC
• Judy Weinstein
• Bonnie Welsh, MA
• Timothy Wever

• Clinical Social Worker in Mendham, NJ
• Providers in Mendham, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; 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.