Individual provider Active NPI

Kendall Rose Savage, LCSW-C

  • Clinical Social Worker
  • Centreville, MD
National Provider Identifier
1174025498
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
23600 Issued in MD
Practice address
202 Coursevall Dr Ste 104
Centreville, MD 21617-2805
Phone
(443) 262-0425
NPI assigned
Mar 2, 2018
Last updated
Apr 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 23600 MD
Clinical Social Worker 1041C0700X 23600 MD Primary

Addresses

Primary practice location

202 Coursevall Dr Ste 104
Centreville, MD 21617-2805

Mailing address

185 Admiral Cochrane Dr Ste 120
Annapolis, MD 21401-7600
Phone (443) 440-5788

Other identifiers 1

IdentifierTypeStateIssuer
185035100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20210826002879 MD Practitioner - Clinical Social Worker 0840695961 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23600MDMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Project Chesapeake, LLC CurrentSince Aug 23, 2021 Accepting new patients
Project Chesapeake, LLC CurrentSince Aug 23, 2021 Accepting new patients
Bay Clinical Laboratories Current Accepting new patients

Locations

108 Old Solomons Island Rd
Ste A
Annapolis, MD 21401
Phone (410) 266-5054

185 Admiral Cochrane Dr
Ste 120
Annapolis, MD 21401

202 Coursevall Dr
Ste 104
Centreville, MD 21617
Phone (443) 262-0425

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1174025498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 ADMIRAL COCHRANE DR STE 120",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017600",
            "telephone_number": "443-440-5788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 COURSEVALL DR STE 104",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216172805",
            "telephone_number": "443-262-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAVAGE",
        "first_name": "KENDALL",
        "middle_name": "ROSE",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-02",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "23600",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "23600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185035100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, MD

Sources for this page

Verify at the official NPI Registry.