Individual provider Active NPI

Kathleen Ann Minora, LCSW

  • Social Worker
  • Wilkes Barre, PA
National Provider Identifier
1275549503
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
SW008995L Issued in PA
Practice address
1111 E End Blvd
Wilkes Barre, PA 18711-0030
Phone
(570) 824-3521
Fax
(570) 821-7299
NPI assigned
Jul 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CW019933 PA
Social Worker 104100000X SW008995L PA Primary

Addresses

Primary practice location

1111 E End Blvd
Wilkes Barre, PA 18711-0030

Mailing address

1111 E End Blvd
Wilkes Barre, PA 18711-0030
Phone (570) 824-3521

Other identifiers 1

IdentifierTypeStateIssuer
SW008995LOtherPASOCIAL WORK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SW008995LPAMDSocial Worker
CW019933PAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1275549503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E END BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110030",
            "telephone_number": "570-824-3521",
            "fax_number": "570-821-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E END BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110030",
            "telephone_number": "570-824-3521",
            "fax_number": "570-821-7299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINORA",
        "first_name": "KATHLEEN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW019933",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW008995L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL WORK",
            "identifier": "SW008995L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.