Khamphady Keovongsa, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9455497-3501 Issued in UT

Practice address

30 Standish Rd
Arlington, MA 02476-7069

Phone

(781) 999-4975

Fax

(801) 263-4333

NPI assigned

Sep 3, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Actualize Counseling & Nutrition LLC

  • Clinical Social Worker
  • Arlington, MA
  • NPI 1316571136
  Medicare reassignment NPD

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

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1194125625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 STANDISH RD",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024767069",
            "telephone_number": "781-999-4975",
            "fax_number": "617-812-1596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 STANDISH RD",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024767069",
            "telephone_number": "781-999-4975",
            "fax_number": "801-263-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEOVONGSA",
        "first_name": "KHAMPHADY",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-03",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "9455497-3501",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "9455497-3502",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Keefe
• Elizabeth Noel Kehrli, MSPT
• Colleen Emma Kelly, MA, BCBA
• Patricia Kelly, LISCW
• Kendra Martin Dermatology
• Lisa Marie Keovongsa, RD, LDN
• Adrienne Kerrigan, M.ED, PCC
• Mark Khalil, DMD
• Aida Mariam Khan, PH.D.
• David W Khoury, MD

• Clinical Social Worker in Arlington, MA
• Providers in Arlington, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.