Kent Paul Radwani, LCSW
Individual provider Active NPI Clinical Social Worker · Providence Forge, VA
NPI 1104902477 · NPPES record last updated Jun 23, 2009
Key facts
- NPI
- 1104902477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0904002086 (VA)
- Practice address
- 9403 Pocohontas Trail
Providence Forge, VA 23140 - Phone
- (804) 966-5959
- NPI assigned
- Oct 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904002086 | VA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth Catholic Charities | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904002086 | VA | Yes |
Addresses
Primary practice location
9403 Pocohontas Trail
Providence Forge, VA 23140
Mailing address
10299 Woodman Rd
Glen Allen, VA 23060-4419
Phone (804) 727-8500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 088888 | Other | VA | SENTARA |
| 4945131 | Other | VA | VIRGINIA PREMIER |
| 177161 | Other | VA | ANTHEM |
Other providers in Providence Forge, VA
- Kim R McFadden
- Ciara Morse
- Oso Wellness PLLC
- Practitioners Heart Healthcare
- Jessica A Pugh
- Srikanth Mahavadi
- Srikanth Mahavadi, DPM PC
- Kristi K Stephens
- Crystal Stewart
- Frank Storey
All providers in Providence Forge, VA · Clinical Social Worker in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.