Kathleen W Park, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2405923 Issued in OH

Practice address

33480 Liberty Pkwy
North Ridgeville, OH 44039-2670

Phone

(440) 732-5252

Fax

(440) 271-2003

NPI assigned

Jan 5, 2022

Last updated

Oct 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Phoenix Counseling Center LLC

  dba The Phoenix Counseling Center LLC

  • Mental Health Counselor
  • North Ridgeville, OH
  • NPI 1992426050
  NPD (past)

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1245991884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33480 LIBERTY PKWY",
            "city": "NORTH RIDGEVILLE",
            "state": "OH",
            "postal_code": "440392670",
            "telephone_number": "440-732-5252",
            "fax_number": "440-271-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33480 LIBERTY PKWY",
            "city": "NORTH RIDGEVILLE",
            "state": "OH",
            "postal_code": "440392670",
            "telephone_number": "440-732-5252",
            "fax_number": "440-271-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KATHLEEN",
        "middle_name": "W",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-05",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2405923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northridge Post Acute Care LLC (Northridge Rehabilitation & Care Center LLC)
• Casey L O'Conor, DDS
• Ohio CVS Stores LLC (CVS Pharmacy 03376)
• On-Site Imaging LLC
• Ontime Home Health Care Staffing
• Jyodi Kiran Patel, DDS
• Mariah Elise Payne
• Kelsey Pease, RN
• Timothy Petrey, LISW
• Phoenix Counseling Center LLC

• Clinical Social Worker in North Ridgeville, OH
• Providers in North Ridgeville, 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 Oct 11, 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.