MEDICARE: MRS. KIERSTEN REBECCA WAMSER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11881	CT
2	1041C0700X	Clinical Social Worker	LC25885	ME
3	1041C0700X	Clinical Social Worker	TPSW5852	FL

General Provider Information

NPI Number	:	1932867751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIERSTEN REBECCA WAMSER LCSW

Provider Business Mailing Address
First Line	:	246 BAYBERRY DR
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1082
Country	:	US
Telephone Number	:	203-217-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 BAYBERRY DR
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1082
Country	:	US
Telephone Number	:	203-217-9050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	04/07/2026

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