Individual provider Active NPI

Katherine A. Smith, LCSW-C

  • Clinical Social Worker
  • Princess Anne, MD
National Provider Identifier
1215151964
Registry record updated Aug 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
13691 Issued in MD
Practice address
11120 Somerset Ave
Princess Anne, MD 21853-2970
Phone
(410) 651-4200
Fax
(410) 651-4290
NPI assigned
Apr 12, 2007
Last updated
Aug 6, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2014

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 13691 MD Primary

Addresses

Primary practice location

11120 Somerset Ave
Princess Anne, MD 21853-2970

Mailing address

2336 Goddard Pkwy
Salisbury, MD 21801-1126
Phone (410) 334-6961

Other identifiers 11

IdentifierTypeStateIssuer
9772653OtherMDAETNA
346646OtherMDMHN
522156095OtherMDAPS
609550004MedicaidMD
R968OtherMDCAREFIRST
522156095OtherMDCIGNA BEHAVIORAL HEALTH
600478097OtherMDMAGELLAN BEHAVIORAL HEALTH
609550001MedicaidMD
522156095OtherMDMHNET BEHAVIORAL HEALTH
LM49EAOtherMDCAREFIRST BCBS OF MARYLAND
522156095OtherMDUBH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080321000109 MD Practitioner - Clinical Social Worker 4688750334 Reassigns benefits to 1 organization
I20240612000078 DC Practitioner - Clinical Social Worker 4688750334 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13691MDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Clinical CurrentSince May 16, 2024 Accepting new patients
Seaside Counseling & Wellness Center, LLC. Clinical CurrentSince Jun 19, 2013 Accepting new patients
Eastern Shore Psychological Services LLC Past Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

314 Franklin Ave
Ste 306
Berlin, MD 21811
Phone (410) 973-2525

8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598

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": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407283200000",
    "number": "1215151964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GODDARD PKWY",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218011126",
            "telephone_number": "410-334-6961",
            "fax_number": "410-334-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11120 SOMERSET AVE",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218532970",
            "telephone_number": "410-651-4200",
            "fax_number": "410-651-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATHERINE",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2014-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "13691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9772653",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "346646",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APS",
            "identifier": "522156095",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609550004",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "R968",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH",
            "identifier": "522156095",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BEHAVIORAL HEALTH",
            "identifier": "600478097",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609550001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHNET BEHAVIORAL HEALTH",
            "identifier": "522156095",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS OF MARYLAND",
            "identifier": "LM49EA",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "522156095",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princess Anne, MD

Sources for this page

Verify at the official NPI Registry.