Individual provider Active NPI

Taylor Kotait, MSW, SISW

  • Clinical Social Worker
  • Midlothian, VA
National Provider Identifier
1396589826
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0906014556 Issued in VA
Practice address
2820 Waterford Lake Dr Ste 100
Midlothian, VA 23112-3994
Phone
(804) 562-7177
NPI assigned
Jun 20, 2024
Last updated
Jun 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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 0906014556 VA Primary

Addresses

Primary practice location

2820 Waterford Lake Dr Ste 100
Midlothian, VA 23112-3994

Mailing address

2820 Waterford Lake Dr Ste 100
Midlothian, VA 23112-3994
Phone (804) 562-7117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20260416000933 VA Practitioner - Clinical Social Worker 5395211478 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Virginia Commonwealth University, School of Medicine, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2820 Waterford Lake Dr
Suite 100
Midlothian, VA 23112-3994

5980 Buckland Mill Rd
Roanoke, VA 24019-6725

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0906014556VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Every Age Every Stage LLC CurrentSince Jun 23, 2024 Accepting new patients

Locations

2820 Waterford Lake Dr
Ste 100
Midlothian, VA 23112
Phone (804) 220-0278

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1396589826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 WATERFORD LAKE DR STE 100",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231123994",
            "telephone_number": "804-562-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 WATERFORD LAKE DR STE 100",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231123994",
            "telephone_number": "804-562-7177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTAIT",
        "first_name": "TAYLOR",
        "credential": "MSW, SISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0906014556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, VA

Sources for this page

Verify at the official NPI Registry.