Individual provider Active NPI

Kim Marie Brown, MSW LISW-S

  • Clinical Social Worker
  • West Chester, OH
National Provider Identifier
1174069835
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I0009222SUPV Issued in OH
Practice address
8904 Brookside Ave
West Chester, OH 45069-3139
Phone
(513) 644-1030
Fax
(513) 644-1025
NPI assigned
Jan 18, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I0009222SUPV OH Primary

Addresses

Primary practice location

8904 Brookside Ave
West Chester, OH 45069-3139

Mailing address

3517 W 8TH St
Cincinnati, OH 45205-2126
Phone (513) 417-4064

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
I0009222SUPVOHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Focus on Youth, Inc. Past Accepting new patients

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": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1174069835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3517 W 8TH ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452052126",
            "telephone_number": "513-417-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8904 BROOKSIDE AVE",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450693139",
            "telephone_number": "513-644-1030",
            "fax_number": "513-644-1025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "KIM",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MSW LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0009222SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.