Individual provider Active NPI

Kym Ludwig, LCSW

  • Clinical Social Worker
  • Woodbridge, VA
National Provider Identifier
1215694807
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904013364 Issued in VA
Practice address
15941 Donald Curtis Dr Ste 200
Woodbridge, VA 22191-4257
Phone
(703) 792-7490
Fax
(703) 792-5699
NPI assigned
Nov 18, 2021
Last updated
Mar 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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 0904013364 VA Primary

Addresses

Primary practice location

15941 Donald Curtis Dr Ste 200
Woodbridge, VA 22191-4257

Mailing address

15941 Donald Curtis Dr Ste 200
Woodbridge, VA 22191-4257
Phone (703) 792-7490

Other names 1

  • Kym Johanson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20220316001179 VA Practitioner - Clinical Social Worker 6507251212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7969 Ashton Ave
Manassas, VA 20109-2885
Phone (703) 792-7800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904013364VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Prince William County Community Services Board CurrentSince Jan 1, 2022 Accepting new patients
Prince William County CurrentSince Jan 1, 2022 Accepting new patients

Locations

7969 Ashton Ave
Manassas, VA 20109
Phone (703) 792-7826

14011 Worth Ave
Ste 110
Woodbridge, VA 22192

15941 Donald Curtis Dr
Ste 200
Woodbridge, VA 22191
Phone (703) 792-4900

Organizations & group practices 2

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": "1637193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1215694807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15941 DONALD CURTIS DR STE 200",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221914257",
            "telephone_number": "703-792-7490",
            "fax_number": "703-792-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15941 DONALD CURTIS DR STE 200",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221914257",
            "telephone_number": "703-792-7490",
            "fax_number": "703-792-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUDWIG",
        "first_name": "KYM",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-18",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYM",
            "last_name": "JOHANSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Woodbridge, VA

Sources for this page

Verify at the official NPI Registry.