BREANNA WARDWELL (NPI# 1508351107) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508351107 |
| Entity Type | Individual |
| Full Name | BREANNA WARDWELL |
| Practice Address |
110 Maple St Ste 110 Springfield MA 01105 |
| Mailing Address |
345 Greenwood St Ste A Worcester MA 01607-1767 |
| Practice Telephone | 4137327419 |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-08-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| Y | 222Q00000X | Developmental Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 345 Greenwood St Ste A, Worcester, MA 016071767 | 5083630200 |
| Street Address |
110 MAPLE ST STE 110 |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588142616 | Isabella R Randazzo | Social Worker | 110 Maple St Ste 110, Springfield, MA 01105-1857 | 2018-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881166551 | Rachael Ellen Buckley | Behavioral Analyst | 1 Federal Street, Stccac Technical Park, Building 101, 1 East-3, Springfield, MA 01105 | 2018-12-19 |
| 1902380017 | Choice Recovery Coaching Inc. | Peer Specialist | 155 Maple St., Suite 305, Springfield, MA 01105 | 2018-09-24 |
| 1538689831 | Ruthie May Therrien | Counselor | 140 High St #230, Springfield, MA 01105 | 2017-06-27 |
| 1124483771 | Jane Danette Smith | Counselor | 15 Mulberry Street, Phoenix House, Springfield, MA 01105 | 2015-12-28 |
| 1043682008 | Nancy Hernandez | Social Worker | 140 High Street Suite 230, South Bay Mental Health Springfield Clinic, Springfield, MA 01105 | 2015-10-29 |
| 1205204567 | Yarelis Aquino | Social Worker | 511 Eastt Columbus Ave, Springfield, MA 01105 | 2015-09-03 |
| 1417376419 | Wanda I Perez | Student in an Organized Health Care Education/Training Program | 367 Pine Street, Springfield, MA 01105 | 2014-04-08 |
| 1275968778 | Elizabeth Catherine Grey | Social Worker | 155 Maple St Ste 304, Springfield, MA 01105 | 2013-09-04 |
| 1891033148 | Carol Ouellette | Counselor | 511 East Columbus Avenue, Springfield, MA 01105 | 2013-01-22 |
| 1699023630 | Julie May Borowski | Counselor | 287 State St., Springfield, MA 01105 | 2012-08-23 |
| Find all providers in zip 01105 | ||||
| Taxonomy Code | 222Q00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Developmental Therapist |
| A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development. |
| Notes: Source: The Illinois Developmental Therapists Association [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841789344 | Felicia Ann Mcguinn | Developmental Therapist | 736 N Bruns Ln Apt B, Springfield, IL 62702-6668 | 2018-05-09 |
| 1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
| 1235559568 | Sarah Colburn | Developmental Therapist | 4927 Margaret Ave, Springfield, IL 62711-9239 | 2014-04-25 |
| 1790105757 | Barbara Fiedler | Developmental Therapist | 209 Bellerive Rd, Springfield, IL 62704-6205 | 2014-04-17 |
| 1396081584 | Louise Elizabeth Johnson | Developmental Therapist | 420 Yeoman Dr, Springfield, IL 62704-5240 | 2012-12-17 |
| 1568722015 | Rebecca Ann Dobbs | Developmental Therapist | 927 N 8th St, Springfield, IL 62702-3939 | 2012-05-17 |
| 1588922397 | Maria Christine Gallina | Developmental Therapist | 1012 W Fayette Ave Apt 2, Springfield, IL 62704-2491 | 2012-04-30 |
| 1851663272 | Barbara J Kelley | Developmental Therapist | 624 S Walnut St, Springfield, IL 62704-2518 | 2012-01-31 |
| 1376828483 | Reagan Egan | Developmental Therapist | 3314 Ashley Ln, Springfield, IL 62711-8257 | 2011-10-20 |
| 1487955506 | Fawn Ann Folkerts | Developmental Therapist | 4504 Blackwolf Rd, Springfield, IL 62711-7871 | 2010-11-04 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 01105 |
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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.