MR. ROBERT J WIEDEMAN (NPI# 1407863681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407863681 |
| Entity Type | Individual |
| Full Name | MR. ROBERT J WIEDEMAN |
| Credential | LMHC------CADAC |
| Practice Address |
72 Jaques Ave Worcester MA 01610-2476 |
| Mailing Address |
44 Sherman Grv Spencer MA 01562-1431 |
| Practice Telephone | 5084214507 |
| Practice Fax Number | 5088601068 |
| Mailing Telephone | 5088859239 |
| Mailing Fax Number | 5088601068 |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 1492 | MA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | LMHC | 1492 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093844714 | Robert Gilbert Wiedeman | Case Manager/Care Coordinator | 438 N White Rd, Alliance for Community Care Service Team Adult Outpatie, San Jose, CA 95127-1439 | 2007-03-06 |
| Street Address |
72 JAQUES AVE |
| City | WORCESTER |
| State | MA |
| Zip Code | 01610-2476 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104898147 | Jordan A Oshlag | Social Worker | 72 Jaques Ave, Worcester, MA 01610-2476 | 2006-02-03 |
| 1811555873 | Victoria Leigh Lenihan | Registered Nurse | 72 Jaques Ave, Worcester, MA 01610-2476 | 2019-06-04 |
| 1386209880 | Rebecca Mauricio | Counselor | 72 Jaques Ave, Worcester, MA 01610-2476 | 2019-05-09 |
| 1336602077 | Cathy A Foulkrod-pickett | Social Worker | 72 Jaques Ave, Worcester, MA 01610-2476 | 2019-04-10 |
| 1639633530 | Yui Kitayama | Nurse Practitioner | 72 Jaques Ave, Worcester, MA 01610-2476 | 2019-01-24 |
| 1477061521 | Kelley Guilfoil-zinkevich | Social Worker | 72 Jaques Ave, Worcester, MA 01610-2476 | 2018-01-10 |
| 1295240117 | Phillip Hodson | Counselor | 72 Jaques Ave, Worcester, MA 01610-2476 | 2017-12-14 |
| 1063923266 | Shanique Boykin | Social Worker | 72 Jaques Ave, Worcester, MA 01610-2476 | 2017-10-16 |
| 1053821744 | Kaden Trifilio | Social Worker | 72 Jaques Ave, Worcester, MA 01610-2476 | 2017-10-07 |
| 1255859559 | Katie Duclos-zagame | Social Worker | 72 Jaques Ave, Worcester, MA 01610-2476 | 2017-09-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881189355 | Amber Hall | Counselor | 26 Queen St, 6th Floor, Worcester, MA 01610 | 2018-06-27 |
| 1417401951 | Kelsey Moran | Counselor | 1 College Street, Box D, Worcester, MA 01610 | 2016-08-13 |
| 1245685809 | Walter Trisdale | Specialist/Technologist | One College St., College of The Holy Cross, Worcester, MA 01610 | 2016-05-02 |
| 1669866430 | Shannon Smith | Student in an Organized Health Care Education/Training Program | 26 Queen St, Ground Floor, Ambulatory Psychiatry Service, Ummmc, Worcester, MA 01610 | 2015-03-19 |
| 1063815348 | Terri Boettcher | Social Worker | 72 Jacques Street, Worcester, MA 01610 | 2014-10-01 |
| 1700222866 | Kalynn Lucashensky | Occupational Therapist | 105 Woodland St. Apt. A, Worcester, MA 01610 | 2013-05-16 |
| 1093053993 | Chrissy Marie Ryan | Registered Nurse | 26 Queen St 6th Floor, Flow Pact, Worcester, MA 01610 | 2013-01-28 |
| 1851681324 | Renaissance Adult Day Care, LLC | Clinic/Center | 1040 Southbridge Street, Worcester, MA 01610 | 2011-04-18 |
| 1912203217 | Goddard/homestead | Custodial Care Facility | 10 Homestead Avenue, Worcester, MA 01610 | 2011-02-03 |
| 1912173196 | Rahman Ullah | Dentist | Park Ave Dental Center, 456 Park Avenue, Worchester, MA 01610 | 2008-05-07 |
| Find all providers in zip 01610 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588271274 | Simon Hayward Waters | Counselor | 67 Rockrimmon Rd, Worcester, MA 01602-2231 | 2020-09-26 |
| 1962015735 | Oumie Hawa Nyassi | Counselor | 78 Upsala St Unit 1, Worcester, MA 01610-2060 | 2020-08-31 |
| 1407470883 | Eliana Catalina Agudelo | Counselor | 259 May St, Worcester, MA 01602-3286 | 2020-06-02 |
| 1720625932 | Richard Jose Figueroa | Counselor | 31 Drexel St, Worcester, MA 01602-1238 | 2019-12-06 |
| 1336794577 | Bailiner Cruz | Counselor | 31 Queen St, Worcester, MA 01610-2456 | 2019-08-05 |
| 1437617552 | Wellbe To Go, Inc. | Counselor | 40 Yukon Ave, Worcester, MA 01605-1630 | 2019-03-07 |
| 1881189355 | Amber Hall | Counselor | 26 Queen St, 6th Floor, Worcester, MA 01610 | 2018-06-27 |
| 1962914614 | Michelle Montanez | Counselor | 21 Dewey St, Worcester, MA 01609-2909 | 2017-11-02 |
| 1528579125 | Rochelle M Santiago | Counselor | 9 Cottage St, Worcester, MA 01609-2301 | 2017-10-23 |
| 1104336593 | Younghwa Kim | Counselor | 2 Granite Street, Worcester, MA 01604 | 2017-10-11 |
| Find all providers in WORCESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.