Susan A Wilson, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37AC00381600 Issued in NJ

Practice address

22-08 Route 208
Fair Lawn, NJ 07410-2609

Phone

(201) 956-6363

NPI assigned

Apr 5, 2018

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

Enrolled in NJ

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

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wellsprings Counseling Center, LLCGroup PAC ID 7618314113, 4 clinicians

Practice addresses (Care Compare)

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.

• Wellsprings Counseling Center, LLC

  • Clinical Social Worker
  • Fair Lawn, NJ
  • NPI 1285844050
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522886400000",
    "number": "1902303035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1347 PADDINGTON RD",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074303258",
            "telephone_number": "551-427-3169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22-08 ROUTE 208",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074102609",
            "telephone_number": "201-956-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SUSAN",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2018-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00381600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Westcott
• Alicia Whilby, LSW
• Linda M Wicker
• Nicholas Wilbur
• Marcus L Williams, M.D.
• Jacqueline Patricia Winnicki, M.ED.
• Wise Owl Therapy
• Emily Wolfson, M.A., CF-SLP
• Victoria E. Wolther, LSW
• Tara Wong, LCSW

• Mental Health Counselor in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.