Keith Patrick Wales, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113671 Issued in MA

Practice address

800 Cummings Ctr
Suite 266T
Beverly, MA 01915-6175

Phone

(978) 921-1190

Fax

(978) 927-3724

NPI assigned

Aug 20, 2006

Sex

Male

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 MA

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

Clinical Social Worker

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eliot Community Human ServicesGroup PAC ID 2062488000, 82 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Eliot Community Human Services

  dba Eliot Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Concord, MA
  • NPI 1679648182
  Medicare reassignment Care Compare group NPD
• Northeast Behavioral Health Corporation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beverly, MA
  • NPI 1154302586
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902911191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CUMMINGS CTR",
            "address_2": "SUITE 266T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156175",
            "telephone_number": "978-921-1190",
            "fax_number": "978-927-3724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CUMMINGS CTR",
            "address_2": "SUITE 266T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156175",
            "telephone_number": "978-921-1190",
            "fax_number": "978-927-3724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALES",
        "first_name": "KEITH",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne S Waite, NYS LMHC, NCC
• Andree Walch, M.A.
• Leonore Kristine Wald, PA-C
• Kristy Waldron
• Nancy Waldron
• Walgreen Co (Rite Aid #10132)
• Walgreen Co (Walgreens #15335)
• Walgreen Eastern Co Inc (Walgreens #04393)
• Walk Well Foot and Lower Extremity Rehabilitation LLC
• Sarah Esther Walker-Brandt

• Clinical Social Worker in Beverly, MA
• Providers in Beverly, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.