Individual provider Active NPI

Casey Nicole Gittens

  • Clinical Social Worker
  • Kenosha, WI
National Provider Identifier
1124752050
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
12524-123 Issued in WI
Practice address
2108 63Rd St
Kenosha, WI 53143-4454
Phone
(262) 652-2406
NPI assigned
Jul 15, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 131551-121 WI
Clinical Social Worker 1041C0700X 12524-123 WI Primary

Addresses

Primary practice location

2108 63Rd St
Kenosha, WI 53143-4454

Mailing address

6233 39TH Ave
Kenosha, WI 53142-7015
Phone (262) 654-1004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250828005270 WI Practitioner - Clinical Social Worker 7214438415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4821 Tanglewood Ave
Racine, WI 53402-2544

6233 39TH Ave
Kenosha, WI 53142-7015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
131551-121WIMDSocial Worker
12524-123WIMDClinical Social Worker
12524WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services Group, Inc. CurrentSince Aug 19, 2025 Accepting new patients

Locations

2108 63rd St
Kenosha, WI 53143

6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004

1205 S 70th St
Ste 301
West Allis, WI 53214
Phone (414) 475-2788

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": "1657843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1124752050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 39TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427015",
            "telephone_number": "262-654-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 63RD ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531434454",
            "telephone_number": "262-652-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GITTENS",
        "first_name": "CASEY",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-15",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "131551-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "12524-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.