Active NPI
Melody Angel Wilson, LCSW
- Clinical Social Worker
- Fairfield, CA
National Provider Identifier
1871959981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904009145
- Practice address
- 101 Bodin Cir BLDG 777
Fairfield, CA 94535-1809 - Phone
- (757) 771-8699
- NPI assigned
- Jan 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904009145 | VA | Primary |
Addresses
Primary practice location
101 Bodin Cir BLDG 777
Fairfield, CA 94535-1809
Mailing address
101 Bodin Cir
Travis Afb, CA 94535-1809
Phone (757) 771-8699
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635465600000",
"number": "1871959981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 BODIN CIR",
"city": "TRAVIS AFB",
"state": "CA",
"postal_code": "945351809",
"telephone_number": "757-771-8699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BODIN CIR BLDG 777",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945351809",
"telephone_number": "757-771-8699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MELODY",
"middle_name": "ANGEL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-05",
"last_updated": "2021-10-29",
"certification_date": "2021-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904009145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; 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.