Active NPI
Katherine C Roberts, LCSW
- Clinical Social Worker
- Hines, IL
National Provider Identifier
1366052417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149021585
- Practice address
- 5000 S 5TH Ave
Hines, IL 60141-3030 - Phone
- (708) 202-8387
- NPI assigned
- Aug 4, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149021585 | IL | Primary |
Addresses
Primary practice location
5000 S 5TH Ave
Hines, IL 60141-3030
Mailing address
17940 66TH CT Apt 1S
Tinley Park, IL 60477-6634
Phone (708) 712-2195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R61151995 | Other | IL | BCBS |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 149021585 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596499200000",
"number": "1366052417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17940 66TH CT APT 1S",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604776634",
"telephone_number": "708-712-2195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 S 5TH AVE",
"city": "HINES",
"state": "IL",
"postal_code": "601413030",
"telephone_number": "708-202-8387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KATHERINE",
"middle_name": "C",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-04",
"last_updated": "2020-08-04",
"certification_date": "2020-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149021585",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "R61151995",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.