Active NPI
R Kevin Douglas, LCSW CASAC
- Clinical Social Worker
- Fishkill, NY
National Provider Identifier
1124366505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 73 080102
- Practice address
- 1073 Main St Ste 202a
Fishkill, NY 12524-3513 - Phone
- (914) 475-4083
- NPI assigned
- Jan 20, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 73 080102 | NY | Primary |
Addresses
Primary practice location
1073 Main St Ste 202a
Fishkill, NY 12524-3513
Mailing address
1073 Main St Ste 202a
Fishkill, NY 12524-3513
Phone (914) 475-4083
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
| License | State | Type | Specialty |
|---|---|---|---|
| 73 080102 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358640000000",
"number": "1124366505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1073 MAIN ST STE 202A",
"city": "FISHKILL",
"state": "NY",
"postal_code": "125243513",
"telephone_number": "914-475-4083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1073 MAIN ST STE 202A",
"city": "FISHKILL",
"state": "NY",
"postal_code": "125243513",
"telephone_number": "914-475-4083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "R",
"middle_name": "KEVIN",
"credential": "LCSW CASAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-20",
"last_updated": "2013-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "73 080102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fishkill, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.