Active NPI
Maryellen Walpole, MSSW
- Clinical Social Worker
- Fairfield, CT
National Provider Identifier
1912173246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 000548
- Practice address
- 400 Stillson Rd
Fairfield, CT 06824-3103 - Phone
- (203) 335-7000
- NPI assigned
- May 6, 2008
- Last updated
- May 6, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 000548 | CT | Primary |
Addresses
Primary practice location
400 Stillson Rd
Fairfield, CT 06824-3103
Mailing address
400 Stillson Rd
Fairfield, CT 06824-3103
Phone (203) 335-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140000548CT01 | Other | CT | ANTHEM BLUE CROSS & BLUE SHIELD |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 000548 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210032000000",
"number": "1912173246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 STILLSON RD",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068243103",
"telephone_number": "203-335-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 STILLSON RD",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068243103",
"telephone_number": "203-335-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALPOLE",
"first_name": "MARYELLEN",
"name_prefix": "Ms.",
"credential": "MSSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-06",
"last_updated": "2008-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "000548",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS & BLUE SHIELD",
"identifier": "140000548CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.