Active NPI
Carmen K Kottha, LISW
- Social Worker
- Beachwood, OH
National Provider Identifier
1003140039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- I.0900019
- Practice address
- 24800 Chagrin Blvd
Suite 103
Beachwood, OH 44122-5648 - Phone
- (216) 245-6231
- Fax
- (216) 245-6351
- NPI assigned
- Sep 23, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | I.0900019 | OH | Primary |
Addresses
Primary practice location
24800 Chagrin Blvd
Suite 103
Beachwood, OH 44122-5648
Mailing address
24800 Chagrin Blvd
Suite 103
Beachwood, OH 44122-5648
Phone (216) 245-6231
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0268768 | Medicaid | OH |
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 |
|---|---|---|---|
| I.0900019 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kortanek Psychological Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Beachwood, OH
- NPI 1053711135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457308800000",
"number": "1003140039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24800 CHAGRIN BLVD",
"address_2": "SUITE 103",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "441225648",
"telephone_number": "216-245-6231",
"fax_number": "216-245-6351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24800 CHAGRIN BLVD",
"address_2": "SUITE 103",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "441225648",
"telephone_number": "216-245-6231",
"fax_number": "216-245-6351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTTHA",
"first_name": "CARMEN",
"middle_name": "K",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-23",
"last_updated": "2016-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "I.0900019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0268768",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beachwood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.