Active NPI
Kerry J Goldsberry, LISW
- Clinical Social Worker
- Bettendorf, IA
National Provider Identifier
1447828884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 107139
- Practice address
- 2550 Middle Rd Ste 602
Bettendorf, IA 52722-3289 - Phone
- (563) 265-1529
- Fax
- (563) 726-7500
- NPI assigned
- Jun 13, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 107139 | IA | Primary |
Addresses
Primary practice location
2550 Middle Rd Ste 602
Bettendorf, IA 52722-3289
Mailing address
2550 Middle Rd Ste 602
Bettendorf, IA 52722-3289
Phone (563) 265-1529
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 29, 2024 through May 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699920000000",
"number": "1447828884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 MIDDLE RD STE 602",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527223289",
"telephone_number": "563-265-1529",
"fax_number": "563-726-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 MIDDLE RD STE 602",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527223289",
"telephone_number": "563-265-1529",
"fax_number": "563-726-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDSBERRY",
"first_name": "KERRY",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-13",
"last_updated": "2023-11-14",
"certification_date": "2023-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IA",
"license": "107139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bettendorf, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.