Kristen Marie O'Dwyer, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801097655 Issued in MI

Practice address

2305 Historic Decatur Rd Ste 100
San Diego, CA 92106

Phone

(619) 708-7100

NPI assigned

Jan 15, 2014

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

Other identifiers 1

Other names 1

• Kristen Marie Carroll Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Wise Practice PLLC

  • Adult Mental Health Clinic/Center
  • Rochester Hills, MI
  • NPI 1801460878
  NPD Authorized official

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1447672191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 HISTORIC DECATUR RD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921066071",
            "telephone_number": "248-891-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 HISTORIC DECATUR RD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92106",
            "telephone_number": "619-708-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 Orchard Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "MI",
            "postal_code": "483412244",
            "country_code": "US",
            "telephone_number": "248-858-7766",
            "fax_number": "248-858-8227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'DWYER",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-15",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801097655",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "09773",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "90773",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "CARROLL",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Austin James O'Donnell
• Frances Jane Durham O'Donnell, M.D.
• Laura A. O'Donnell, M.D.
• Robert H. O'Donnell, M.D.
• Stephen Patrick O'Donnell, DDS
• Mary Margaret O'Dwyer, M.D.
• Kathleen Anne O'Farrell, M.D.
• Kate Michelle O'Flaherty-Keese, P.N.P.
• Elizabeth A. O'Grady, LCSW
• Denise O'Hagan, P.T.

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.