NPIMap

Individual provider Active NPI

Kim Maxwell Fish, LCSW, LMHC

  • Clinical Social Worker
  • Fort Wayne, IN
National Provider Identifier
1093869133
Registry record updated Feb 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34004143A Issued in IN
Practice address
3948 New Vision Dr Ste D
Fort Wayne, IN 46845-1721
Phone
(260) 407-7285
NPI assigned
Jan 23, 2007
Last updated
Feb 25, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 39000977A IN
Clinical Social Worker 1041C0700X I 0800371 OH
Clinical Social Worker 1041C0700X 34004143A IN Primary

Addresses

Primary practice location

3948 New Vision Dr Ste D
Fort Wayne, IN 46845-1721

Mailing address

4903 Coventry Pkwy
Fort Wayne, IN 46804-7133
Phone (419) 559-6370

Other names 1

  • Mrs. Kim S Fish Other name

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

LicenseStateTypeSpecialty
39000977AINMDMental Health Counselor
34004143AINMDClinical Social Worker
I 0800371OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bonnie Kiser LLC Past Accepting new patients
Vision Counseling and Psychological Services, PC Past Accepting new patients
Cornerstone Counseling & Consulting, P.C, Past Accepting new patients

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": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298592000000",
    "number": "1093869133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4903 COVENTRY PKWY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047133",
            "telephone_number": "419-559-6370",
            "fax_number": "260-407-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3948 NEW VISION DR STE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451721",
            "telephone_number": "260-407-7285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISH",
        "first_name": "KIM",
        "middle_name": "MAXWELL",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2011-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39000977A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I 0800371",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34004143A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "FISH",
            "middle_name": "S",
            "prefix": "MRS.",
            "credential": "LCSW, LISW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2011; 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.