Individual provider Active NPI

Kathleen Ann Farrell-Perrini, MSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1053726406
Registry record updated Jun 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
68801083233 Issued in MI
Practice address
360 Division Ave S Ste 3a
Grand Rapids, MI 49503-4501
Phone
(616) 988-9389
Fax
(616) 732-6392
NPI assigned
Jun 24, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2014

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 68801083233 MI Primary

Addresses

Primary practice location

360 Division Ave S Ste 3a
Grand Rapids, MI 49503-4501

Mailing address

4758 Cascade Ave
Rock Hill, SC 29732-8190
Phone (803) 487-8267

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20160826001574 SC Practitioner - Clinical Social Worker 8325008394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

1030 Riverwalk Pkwy
Suite 203
Rock Hill, SC 29730-4265
Phone (803) 368-6499

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
68801083233MIMDClinical Social Worker
11035SCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Dec 28, 2020 Accepting new patients
Catholic Charities of Shiawassee and Genesee Counties Past Accepting new patients
Catholic Charities of Shiawassee and Genesee Counties PastSince Aug 17, 2016 Accepting new patients

Locations

4975 Lacross Rd
Ste 351
North Charleston, SC 29406
Phone (800) 309-1159

1030 Riverwalk Pkwy
Ste 203
Rock Hill, SC 29730
Phone (803) 368-6499

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1053726406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4758 CASCADE AVE",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297328190",
            "telephone_number": "803-487-8267",
            "fax_number": "803-324-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 DIVISION AVE S STE 3A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034501",
            "telephone_number": "616-988-9389",
            "fax_number": "616-732-6392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRELL-PERRINI",
        "first_name": "KATHLEEN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-24",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "68801083233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.