Kelly Macmullin, LISW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

I.1700661-SUPV Issued in OH

Practice address

3922 Lovers LN
Ravenna, OH 44266-4200

Phone

(330) 296-3555

NPI assigned

May 25, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coleman Professional Services, Inc.

  • Mental Health Counselor
  • Kent, OH
  • NPI 1982637633

  Social Worker

  Medicare reassignment NPD

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

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624752000000",
    "number": "1427549328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5982 RHODES RD",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442408100",
            "telephone_number": "330-637-1347",
            "fax_number": "330-678-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3922 LOVERS LN",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442664200",
            "telephone_number": "330-296-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACMULLIN",
        "first_name": "KELLY",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-25",
        "last_updated": "2021-06-27",
        "certification_date": "2021-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.1700661",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.1700661-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nasir Stewart Lytle
• M&J Medical Supply
• Angel Mack, SW-T
• Patricia Rose Mack
• Jeffery David Macmonigal
• Carmela Macreno
• Karla Jeanne Madalin, MD
• Stacy Maddox
• Billy James Magnus II, LPN
• John Francis Mahlmeister III

• Social Worker in Ravenna, OH
• Providers in Ravenna, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2021; 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.