Providence Psychological Services Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

09040007534 Issued in VA

Legal business name

PROVIDENCE PSYCHOLOGICAL SERVICES INC

Practice address

129 N Saratoga St
Ste 1
Suffolk, VA 23434-5255

Phone

(757) 539-5353

Fax

(757) 539-5399

NPI assigned

May 17, 2013

Organization subpart

No

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

Authorized official

Name

Kawanna Evette Ward, LCSW, CSAC, CSOTPNPI 1043515331

Title

Ceo

Phone

(757) 535-7839

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kawanna Evette Ward, LCSW, CSAC, CSOTP

  • Clinical Social Worker
  • Portsmouth, VA
  • NPI 1043515331
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368748800000",
    "number": "1487090429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 N SARATOGA ST",
            "address_2": "STE 1",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234345255",
            "telephone_number": "757-539-5353",
            "fax_number": "757-539-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 N SARATOGA ST",
            "address_2": "STE 1",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234345255",
            "telephone_number": "757-539-5353",
            "fax_number": "757-539-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PSYCHOLOGICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-17",
        "last_updated": "2013-05-17",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "KAWANNA",
        "authorized_official_middle_name": "EVETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-535-7839",
        "authorized_official_credential": "LCSW, CSAC, CSOTP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "09040007534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.