Individual provider Active NPI

William J Mathias, LCSW

  • Clinical Social Worker
  • Green Bay, WI
National Provider Identifier
1912071101
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2091-123 Issued in WI
Practice address
130 E Walnut St
Suite 706
Green Bay, WI 54301-4239
Phone
(920) 437-8256
Fax
(920) 437-1188
NPI assigned
Nov 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2091-123 WI Primary

Addresses

Primary practice location

130 E Walnut St
Suite 706
Green Bay, WI 54301-4239

Mailing address

130 E Walnut St
Suite 706
Green Bay, WI 54301-4239
Phone (920) 437-8256

Other identifiers 1

IdentifierTypeStateIssuer
39257500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2091-123WIMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912071101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E WALNUT ST",
            "address_2": "SUITE 706",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014239",
            "telephone_number": "920-437-8256",
            "fax_number": "920-437-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E WALNUT ST",
            "address_2": "SUITE 706",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014239",
            "telephone_number": "920-437-8256",
            "fax_number": "920-437-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIAS",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2091-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39257500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.