Active NPI
Kelly Kolkmeyer
- Clinical Social Worker
- Long Beach, CA
National Provider Identifier
1427593490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW108502
- Practice address
- 4001 Long Beach Blvd
Long Beach, CA 90807-2616 - Phone
- (562) 427-7671
- NPI assigned
- Dec 30, 2016
- Last updated
- Jun 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW108502 | CA | Primary |
| Clinical Social Worker | 1041C0700X |
Addresses
Primary practice location
4001 Long Beach Blvd
Long Beach, CA 90807-2616
Mailing address
349 Virginia St Apt 1
El Segundo, CA 90245-2977
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 |
|---|---|---|---|
| LCSW108502 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| For the Child, Inc. | Past | Accepting new patients | |
| Associated Therapists, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
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-
- Voluntary or Charitable Agency
- Long Beach, CA
- NPI 1144354275
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655769600000",
"number": "1427593490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "349 VIRGINIA ST APT 1",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 LONG BEACH BLVD",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908072616",
"telephone_number": "562-427-7671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLKMEYER",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-30",
"last_updated": "2022-06-21",
"certification_date": "2022-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW108502",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.