Charles William Ketchel, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R031920 Issued in NY

Practice address

28 Forest LN
Faber, VA 22938-2328

Phone

(845) 758-2220

NPI assigned

Jun 25, 2013

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

Other names 1

• Chuck Ketchel Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 17, 2023 through Jan 17, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1225478167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 FOREST LN",
            "city": "FABER",
            "state": "VA",
            "postal_code": "229382328",
            "telephone_number": "845-758-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 FOREST LN",
            "city": "FABER",
            "state": "VA",
            "postal_code": "229382328",
            "telephone_number": "845-758-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHEL",
        "first_name": "CHARLES",
        "middle_name": "WILLIAM",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-25",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "904011232",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R031920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHUCK",
            "last_name": "KETCHEL",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• All N 1 Transportation, LLC
• Suzanne Evans Morris, PH.D.

• Clinical Social Worker in Faber, VA
• Providers in Faber, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.