Amanda Gabrielle Kacena, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

39001619A Issued in IN

Legal business name

AMANDA GABRIELLE KACENA, LLC

Practice address

2005 Valparaiso St Ste 106
Valparaiso, IN 46383-3330

Phone

(312) 590-7140

NPI assigned

Oct 17, 2017

Organization subpart

No

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

Authorized official

Name

Amanda Gabrielle Kacena, LCSW

Title

Owner

Phone

(312) 590-7140

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508198400000",
    "number": "1104337195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 BRENTWOOD DR",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463831373",
            "telephone_number": "312-590-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 VALPARAISO ST STE 106",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463833330",
            "telephone_number": "312-590-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANDA GABRIELLE KACENA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A",
        "authorized_official_last_name": "KACENA",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "GABRIELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-590-7140",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "39001619A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "39001619A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; 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.