Active NPI
Kevin R Anderson, LCSW
- Clinical Social Worker
- Anderson, IN
National Provider Identifier
1003173253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34000491A
- Practice address
- 2210 Jackson St
Anderson, IN 46016-4363 - Phone
- (765) 683-3118
- NPI assigned
- Apr 12, 2012
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34000491A | IN | Primary |
Addresses
Primary practice location
2210 Jackson St
Anderson, IN 46016-4363
Mailing address
10330 N Meridian St # 300
Indianapolis, IN 46290-1024
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34000491A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483920000000",
"number": "1003173253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10330 N MERIDIAN ST # 300",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462901024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2210 JACKSON ST",
"city": "ANDERSON",
"state": "IN",
"postal_code": "460164363",
"telephone_number": "765-683-3118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "KEVIN",
"middle_name": "R",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-12",
"last_updated": "2017-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34000491A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anderson, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.