Kelly Fallon, MSW, LISW-S, LCSW
Individual provider Active NPI Clinical Social Worker · Erlanger, KY
NPI 1194119941 · NPPES record last updated Dec 18, 2020
Key facts
- NPI
- 1194119941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 254010 (KY)
- Practice address
- 4220 Houston Rd
Erlanger, KY 41018-3402 - Phone
- (502) 262-2887
- NPI assigned
- Mar 18, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
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 |
|---|---|---|---|---|
| I20220815001465 | OH | Practitioner - Clinical Social Worker | 8224441803 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindfully, LLC | Social Worker | Current |
Accepting new patients |
| Specialized Alternatives for Families and Youth of Ohio, Inc. | Past | Accepting new patients | |
| Mindfully Psychiatry LLC | Past | Accepting new patients |
Locations
199 S Chillicothe Rd
Ste 207
Aurora, OH 44202
5630 Bridgetown Rd
Ste 4
Cincinnati, OH 45248
Phone (513) 252-8054
8040 Hosbrook Rd
Ste 320
Cincinnati, OH 45236
Phone (513) 861-9797
100 E Campus View Blvd
Ste 250
Columbus, OH 43235
Phone (267) 817-8902
10861 Yankee St
Dayton, OH 45458
Phone (937) 619-0800
5050 Blazer Pkwy
Ste 101
Dublin, OH 43017
Phone (614) 451-7346
1251 Nilles Rd
Ste 5
Fairfield, OH 45014
Phone (732) 993-4599
6100 Oak Tree Blvd
Ste 200
Independence, OH 44131
Phone (330) 344-9030
1715 Indian Wood Cir
Ste 200
Maumee, OH 43537
Phone (216) 770-9367
10547 Montgomery Rd
Ste 700
Montgomery, OH 45242
Phone (513) 393-0300
110 S College Ave
Fl 2
Oxford, OH 45056
Phone (513) 273-0020
11565 Pearl Rd
Ste 200
Strongsville, OH 44136
Phone (440) 846-0862
3000 Regency Ct
Ste 207
Toledo, OH 43623
Phone (419) 471-0493
5900 W Chester Rd
Ste C
West Chester, OH 45069
Phone (513) 777-2428
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 254010 | KY | |
| Clinical Social Worker | 1041C0700X | I.1201146-SUPV | OH | |
| Clinical Social Worker | 1041C0700X | 254010 | KY | Yes |
Addresses
Primary practice location
4220 Houston Rd
Erlanger, KY 41018-3402
Mailing address
8665 Tudor CT
Cincinnati, OH 45242-7836
Phone (513) 771-7239
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100660700 | Medicaid | KY | |
| 0176667 | Medicaid | OH |
Other providers in Erlanger, KY
- Edward R. Eilers Jr.
- Ofonime John Ekpe
- Michael P Elliott
- Erlanger Chiropractic, PSC
- Erlanger-Elsmere Board of Education
- William J Farrell
- Jonathan Matthew Feeley
- Emma Feldman
- Tricia Lynn Fischer
- James Flanagan
All providers in Erlanger, KY · Clinical Social Worker in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2020. 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.