Active NPI
Kathleen Ann Gewalt, LCSW
- Clinical Social Worker
- Holly Springs, NC
National Provider Identifier
1053337766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904 002834
- Practice address
- 239 Thorndale Dr.
Holly Springs, NC 27540-5517 - Phone
- (919) 363-0713
- Fax
- (703) 866-4787
- NPI assigned
- Jul 14, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 0904 002834 | VA | Primary |
Addresses
Primary practice location
239 Thorndale Dr.
Holly Springs, NC 27540-5517
Mailing address
239 Thorndale Dr.
Holly Springs, NC 27540-5517
Phone (919) 363-0713
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 |
|---|---|---|---|
| 0904 002834 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053337766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 THORNDALE DR.",
"city": "HOLLY SPRINGS",
"state": "NC",
"postal_code": "275405517",
"telephone_number": "919-363-0713",
"fax_number": "703-866-4787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "239 THORNDALE DR.",
"city": "HOLLY SPRINGS",
"state": "NC",
"postal_code": "275405517",
"telephone_number": "919-363-0713",
"fax_number": "703-866-4787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEWALT",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904 002834",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holly Springs, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.