Active NPI
Bryant Willis Walls, LICSW
- School Social Worker
- Natick, MA
National Provider Identifier
1972078657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- 114169-SW-LICSW
- Practice address
- 22 Rutledge Rd
Natick, MA 01760-1729 - Phone
- (508) 647-6400
- NPI assigned
- Oct 9, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | 114169-SW-LICSW | MA | Primary |
Addresses
Primary practice location
22 Rutledge Rd
Natick, MA 01760-1729
Mailing address
30 Merriam Way
Upton, MA 01568-1675
Phone (508) 647-6400
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114169-SW-LICSW | MA | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539043200000",
"number": "1972078657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 MERRIAM WAY",
"city": "UPTON",
"state": "MA",
"postal_code": "015681675",
"telephone_number": "508-647-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 RUTLEDGE RD",
"city": "NATICK",
"state": "MA",
"postal_code": "017601729",
"telephone_number": "508-647-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLS",
"first_name": "BRYANT",
"middle_name": "WILLIS",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-09",
"last_updated": "2018-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "MA",
"license": "114169-SW-LICSW",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Natick, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.