Mackrea G Larue, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2102767 Issued in OH

Practice address

6779 Orchard Trail Rd NE
Canton, OH 44721-2526

Phone

(234) 401-0012

NPI assigned

Jun 20, 2018

Last updated

Jan 30, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mackrea G Kilpatrick Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rize Up Counseling, LLC

  • Mental Health Counselor
  • Canton, OH
  • NPI 1619688850
  Medicare reassignment NPD

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1215421441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6779 ORCHARD TRAIL RD NE",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447212526",
            "telephone_number": "234-401-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6779 ORCHARD TRAIL RD NE",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447212526",
            "telephone_number": "234-401-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARUE",
        "first_name": "MACKREA",
        "middle_name": "G",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-20",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2102767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKREA",
            "last_name": "KILPATRICK",
            "middle_name": "G",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacob Lark, DPT
• Brandi Larney
• Larry McKinstry Services LLC (mrdd service provider fpr mrdd clients)
• Alexandra Renee Larson, PT
• Bria Larsuel
• Christopher Larussa, DO
• Theresa Lash, E.1901131-SUPV
• Katherine Anne Lasher, FNP-C
• Sehan Siraj Lashkerwala, MD
• Diana Lashley

• Clinical Social Worker in Canton, OH
• Providers in Canton, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.