Individual provider Active NPI

Cora Marie Kutnick, LLMSW

  • Clinical Social Worker
  • Plymouth, MI
National Provider Identifier
1023696606
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801105060 Issued in MI
Practice address
496 W Ann Arbor TRL Ste 202
Plymouth, MI 48170-6262
Phone
(734) 414-1373
NPI assigned
Apr 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801105060 MI Primary

Addresses

Primary practice location

496 W Ann Arbor TRL Ste 202
Plymouth, MI 48170-6262

Mailing address

496 W Ann Arbor TRL Ste 202
Plymouth, MI 48170-6262
Phone (734) 787-6908

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

LicenseStateTypeSpecialty
6801105060MIMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1023696606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 W ANN ARBOR TRL STE 202",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481706262",
            "telephone_number": "734-787-6908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 W ANN ARBOR TRL STE 202",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481706262",
            "telephone_number": "734-414-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTNICK",
        "first_name": "CORA",
        "middle_name": "MARIE",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-01",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801105060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.