Individual provider Active NPI

Rebecca Bennett Katovsich, PHD, LLP, LMSW

  • Clinical Social Worker
  • Saint Joseph, MI
National Provider Identifier
1063512671
Registry record updated Feb 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801080778 Issued in MI
Practice address
903 Main St
Saint Joseph, MI 49085-1426
Phone
(269) 985-2000
Fax
(269) 985-2002
NPI assigned
Sep 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2009

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801080778 MI
Clinical Psychologist 103TC0700X 6301013818 MI
Clinical Social Worker 1041C0700X 6801080778 MI Primary
Psychologist 103T00000X 6301013818 MI

Addresses

Primary practice location

903 Main St
Saint Joseph, MI 49085-1426

Mailing address

903 Main St
Saint Joseph, MI 49085-1426
Phone (269) 985-2000

Other identifiers 2

IdentifierTypeStateIssuer
RK080778OtherMIBLUE CROSS BLUE SHIELD
8008979580OtherMIBCBS

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301013818MIMDClinical Psychologist
6801080778MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Shepard House Counseling & Psychological Services, P.C. Clinical Past Accepting new patients

Organizations & group practices 1

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": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234483200000",
    "number": "1063512671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 MAIN ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851426",
            "telephone_number": "269-985-2000",
            "fax_number": "269-985-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 MAIN ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851426",
            "telephone_number": "269-985-2000",
            "fax_number": "269-985-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATOVSICH",
        "first_name": "REBECCA",
        "middle_name": "BENNETT",
        "name_prefix": "Dr.",
        "credential": "PHD, LLP, LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2009-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801080778",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013818",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801080778",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301013818",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "RK080778",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8008979580",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2009; 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.