Kelly Bencivenni
Individual provider Active NPI Clinical Social Worker · Chardon, OH
NPI 1184087702 · NPPES record last updated Sep 4, 2018
Key facts
- NPI
- 1184087702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- I.1700035 (OH)
- Practice address
- 695 South St
Suite 6
Chardon, OH 44024 - Phone
- (440) 286-1553
- Fax
- (440) 286-1318
- NPI assigned
- Mar 31, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231205002886 | OH | Practitioner - Clinical Social Worker | 9032488200 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I.1700035 | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Pride of Northeast Ohio Incorporated | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I.1700035 | OH | Yes |
Addresses
Primary practice location
695 South St
Suite 6
Chardon, OH 44024
Mailing address
695 South St
Suite 6
Chardon, OH 44024-1474
Phone (440) 286-1553
NPI Registry JSON
{
"created_epoch": "1459382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536019200000",
"number": "1184087702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "695 SOUTH ST",
"address_2": "SUITE 6",
"city": "CHARDON",
"state": "OH",
"postal_code": "440241474",
"telephone_number": "440-286-1553",
"fax_number": "440-286-1318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "695 SOUTH ST",
"address_2": "SUITE 6",
"city": "CHARDON",
"state": "OH",
"postal_code": "44024",
"telephone_number": "440-286-1553",
"fax_number": "440-286-1318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENCIVENNI",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-31",
"last_updated": "2018-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.1700035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chardon, OH
- Agustus A Beck
- Louise Rosalee Bednarski
- Mary-Alice Bell
- Olivia Bell
- Justin Robert Belle
- Cory Bennet
- Amy Bennett
- Ethan Bennington
- Michelle Olivia Benz
- Caroline Berlin
All providers in Chardon, OH · Clinical Social Worker in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.