Dina Marie Douglas, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I9747SUPV Issued in OH

Practice address

143 Gougler Ave
Kent, OH 44240-2401

Phone

(330) 677-4124

NPI assigned

May 30, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kelly Reeves Memorial Foundation

  dba Kelly's Grief Center

  • Professional Counselor
  • Kent, OH
  • NPI 1295220986
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527638400000",
    "number": "1023500691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 HIGH ST",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442403803",
            "telephone_number": "330-310-3164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 GOUGLER AVE",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442402401",
            "telephone_number": "330-677-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "DINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-30",
        "last_updated": "2018-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I9747SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Marie Dolbow, LPN
• Mildred Louise Domnie
• Kristin Lee Donaldson
• Jelani Dorsey
• Katrina Lynn Dotterweich
• Lori Larson Draper, LPN
• Barbara Lynn Drew, RN, CNS
• Kathleen Elizabeth Drown
• Anna Drozdik
• Shequielle D Drummond

• Clinical Social Worker in Kent, OH
• Providers in Kent, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.