Individual provider Active NPI

Kevonyah Edwards, LSW, LICDC

  • Clinical Social Worker
  • Cincinnati, OH
National Provider Identifier
1407345663
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
S.1903703 Issued in OH
Practice address
954 W North Bend Rd Ste 304B
Cincinnati, OH 45224-2250
Phone
(513) 237-8390
NPI assigned
May 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LICDC.161852 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X LCDCIII.161445 OH
Clinical Social Worker 1041C0700X S.1903703 OH Primary

Addresses

Primary practice location

954 W North Bend Rd Ste 304B
Cincinnati, OH 45224-2250

Mailing address

526 W 113TH St Apt 1
New York, NY 10025-8016
Phone (513) 237-8390

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
LCDCIII.161445OHMDAddiction (Substance Use Disorder) Counselor
LICDC.161852OHMDAddiction (Substance Use Disorder) Counselor
S.1903703OHMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1407345663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 W 113TH ST APT 1",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100258016",
            "telephone_number": "513-237-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 W NORTH BEND RD STE 304B",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452242250",
            "telephone_number": "513-237-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "KEVONYAH",
        "credential": "LSW, LICDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-03",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.161852",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.161445",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S.1903703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.