Individual provider Active NPI

Kathryn A Lawrence, MSW, LCSW

  • Clinical Social Worker
  • Portland, IN
National Provider Identifier
1053566182
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34007473A Issued in IN
Practice address
216 S Meridian St
Portland, IN 47371-2115
Phone
(260) 251-6928
NPI assigned
Nov 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
School Counselor 101YS0200X
Clinical Social Worker 1041C0700X
Clinical Social Worker 1041C0700X 34007473A IN Primary

Addresses

Primary practice location

216 S Meridian St
Portland, IN 47371-2115

Mailing address

216 S Meridian St
Portland, IN 47371-2115
Phone (260) 251-6928

Other practice location 1

6105 Constitution Dr
Fort Wayne, IN 46804-1525
Phone (260) 450-9665

Other names 1

  • Kathryn A Davidson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20221005002801 IN Practitioner - Clinical Social Worker 9830575448 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
R P Therapy LLCGroup PAC ID 4789076373, 8 clinicians

Practice addresses (Care Compare)

101 Oak St
Portland, IN 47371-3040
Phone (317) 727-9223

6326 Constitution Dr
Fort Wayne, IN 46804-1518
Phone (260) 515-3275

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34007473AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
K a Lawrence LLC Clinical CurrentSince May 1, 2023 Accepting new patients
R P Therapy LLC CurrentSince Aug 15, 2022 Accepting new patients
Community Health Network, Inc. Past Accepting new patients
Community Health Network, Inc Past Accepting new patients

Locations

6326 Constitution Dr
Fort Wayne, IN 46804
Phone (260) 515-3275

216 S Meridian St
Portland, IN 47371
Phone (260) 251-6928

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1053566182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 S MERIDIAN ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473712115",
            "telephone_number": "260-251-6928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 S MERIDIAN ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473712115",
            "telephone_number": "260-251-6928"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6105 Constitution Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468041525",
            "country_code": "US",
            "telephone_number": "260-450-9665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "KATHRYN",
        "middle_name": "A",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-17",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007473A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "DAVIDSON",
            "middle_name": "A",
            "credential": "MSW, LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, IN

Sources for this page

Verify at the official NPI Registry.