Individual provider Active NPI

Alyssa Carothers, MSSA, LSW

  • Social Worker
  • Mentor, OH
National Provider Identifier
1023745254
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S1802347 Issued in OH
Practice address
8445 Munson Rd
Mentor, OH 44060-2410
Phone
(440) 255-1700
Fax
(440) 205-2417
NPI assigned
Aug 8, 2022
Last updated
Dec 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X S.1802347 OH
Social Worker 104100000X S1802347 OH Primary

Addresses

Primary practice location

8445 Munson Rd
Mentor, OH 44060-2410

Mailing address

8445 Munson Rd
Mentor, OH 44060-2410
Phone (440) 255-1700

Other identifiers 1

IdentifierTypeStateIssuer
2864093MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S1802347OHMDSocial Worker
S.1802347OHMDCommunity/Behavioral Health Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Health, Inc CurrentSince Aug 26, 2024 Accepting new patients
Signature Health, Inc. Current Accepting new patients
Signature Health Inc CurrentSince Aug 26, 2024 Accepting new patients

Locations

21100 Southgate Park Blvd
Maple Heights, OH 44137
Phone (216) 663-6100

7232 Justin Way
Mentor, OH 44060
Phone (440) 488-2855

38876 Mentor Ave
Willoughby, OH 44094
Phone (440) 954-3333

38882 Mentor Ave
Willoughby, OH 44094

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1023745254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8445 MUNSON RD",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440602410",
            "telephone_number": "440-255-1700",
            "fax_number": "440-205-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8445 MUNSON RD",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440602410",
            "telephone_number": "440-255-1700",
            "fax_number": "440-205-2417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAROTHERS",
        "first_name": "ALYSSA",
        "credential": "MSSA, LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-08",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OH",
            "license": "S.1802347",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S1802347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2864093",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.