Wayne R. Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW91441 Issued in CA

Practice address

70 East Terrace Dr
Altadena, CA 91101

Phone

(707) 797-0064

NPI assigned

Jan 31, 2017

Last updated

Aug 8, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Doc Wilson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: wayne.wilson.1@25119.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crescendo Behavioral Health LLC

  • Clinical Social Worker
  • Altadena, CA
  • NPI 1992486443
  NPD
• Childnet Youth and Family Services, Inc.

  • Community/Behavioral Health Agency
  • Riverside, CA
  • NPI 1275991465
  NPD (past)

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

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1841737673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 BRIDGE ST UNIT 11",
            "city": "VERNONIA",
            "state": "OR",
            "postal_code": "970641285",
            "telephone_number": "707-797-0064",
            "fax_number": "707-797-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 EAST TERRACE DR",
            "city": "ALTADENA",
            "state": "CA",
            "postal_code": "91101",
            "telephone_number": "707-797-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WAYNE",
        "middle_name": "R.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-31",
        "last_updated": "2024-08-08",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW75482",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW91441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOC",
            "last_name": "WILSON",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kiarra Williams I
• Lawrence Christopher Williams
• Patricia Ramos Williams, R.N.
• Jaime M Wilson
• Kelly Ann Wilson
• Emily Jessica Wong, MSW
• Shelly S Wong, LCSW
• Joseph Meredith Wray
• Leslie Anne Wright, PSYD
• Linna Xiong

• Clinical Social Worker in Altadena, CA
• Providers in Altadena, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.