Individual provider Active NPI

Kristen Williams, LCSW

  • Clinical Social Worker
  • Ridgway, PA
National Provider Identifier
1225558471
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CW019490 Issued in PA
Practice address
43 Servidea Dr
Ridgway, PA 15853-6333
Phone
(814) 776-2145
Fax
(814) 776-1470
NPI assigned
Jun 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 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 CW019490 PA Primary

Addresses

Primary practice location

43 Servidea Dr
Ridgway, PA 15853-6333

Mailing address

43 Servidea Dr
Ridgway, PA 15853-6333
Phone (814) 776-2145

Other names 1

  • Kristen Detwiler Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20170825000016 PA Practitioner - Clinical Social Worker 3779855705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Insight Therapy LLCGroup PAC ID 7618303660, 3 clinicians

Practice addresses (Care Compare)

106 Wehler Rd
Saint Marys, PA 15857-2138
Phone (814) 558-7593

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CW019490PAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cen Clear Child Services, Inc. CurrentSince Jan 6, 2020 Accepting new patients

Locations

50 Bigler Rd
Woodland, PA 16881

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1225558471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 SERVIDEA DR",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158536333",
            "telephone_number": "814-776-2145",
            "fax_number": "814-776-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 SERVIDEA DR",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158536333",
            "telephone_number": "814-776-2145",
            "fax_number": "814-776-1470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KRISTEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW019490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "DETWILER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ridgway, PA

Sources for this page

Verify at the official NPI Registry.