Kristen M Kotheimer, MSW, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2002411-SUPV Issued in OH

Practice address

520 Youngstown Poland Rd
Struthers, OH 44471-1103

Phone

(330) 318-3078

Fax

(234) 855-1072

NPI assigned

May 11, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Locations

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.

• Psy-Care Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Youngstown, OH
  • NPI 1396705349

  Clinical

  Medicare reassignment NPD
• Psycare, Inc.

  • Community/Behavioral Health Agency
  • Struthers, OH
  • NPI 1104462589
  NPD

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1245766062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051834",
            "telephone_number": "330-759-0276",
            "fax_number": "330-759-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 YOUNGSTOWN POLAND RD",
            "city": "STRUTHERS",
            "state": "OH",
            "postal_code": "444711103",
            "telephone_number": "330-318-3078",
            "fax_number": "234-855-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHEIMER",
        "first_name": "KRISTEN",
        "middle_name": "M",
        "credential": "MSW, LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-11",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2002411-SUPV",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S.1302238",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Jones
• Joseph Jose MD LLC
• Virginia S. Kehoe-Buzas, RN
• Teri Lynn Kempton, LPCC
• James Melvin Kline, D.O.
• Denise R Kuhlman
• Donna Kusior, LPN
• Deonna Lampley
• Michael L Leffler, LPN
• Janeata Leggett

• Clinical Social Worker in Struthers, OH
• Providers in Struthers, 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 Dec 28, 2021; 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.