Individual provider Active NPI

Katherine Wheeler, LCSW

  • Clinical Social Worker
  • Waterloo, NY
National Provider Identifier
1154932119
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
097594 Issued in NY
Practice address
12 E River St
Waterloo, NY 13165-1733
Phone
(315) 758-0587
NPI assigned
Aug 13, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Clinical Social Worker 1041C0700X 097594 NY Primary

Addresses

Primary practice location

12 E River St
Waterloo, NY 13165-1733

Mailing address

12 E River St
Waterloo, NY 13165-1733
Phone (315) 758-0587

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20241021001557 NY Practitioner - Clinical Social Worker 3971035510 Reassigns benefits to 1 organization
Practice locations: Waterloo, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of New England, College of Osteo Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Practice addresses (Care Compare)

300 Cadman PLZ W
Brooklyn, NY 11201-3211
Phone (323) 205-7088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Specialty Group PA CurrentSince May 1, 2025 Accepting new patients
Connected Treasures. LCSW, PLLC Clinical CurrentSince Nov 3, 2024 Accepting new patients

Locations

106 High St
Ste B
Newark, NY 14513
Phone (315) 758-0587

Organizations & group practices 2

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": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1154932119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E RIVER ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651733",
            "telephone_number": "315-758-0587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 E RIVER ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651733",
            "telephone_number": "315-758-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELER",
        "first_name": "KATHERINE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-13",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "097594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, NY

Sources for this page

Verify at the official NPI Registry.