Individual provider Active NPI

McKenna Garvey, LCSW

  • Clinical Social Worker
  • Appleton, WI
National Provider Identifier
1508484833
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9818-123 Issued in WI
Practice address
4650 W Spencer St
Appleton, WI 54914-9106
Phone
(920) 903-1060
Fax
(920) 903-1060
NPI assigned
Jul 13, 2020
Last updated
Sep 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 9818-123 WI Primary

Addresses

Primary practice location

4650 W Spencer St
Appleton, WI 54914-9106

Mailing address

4650 W Spencer St
Appleton, WI 54914-9106
Phone (920) 903-1060

Other identifiers 1

IdentifierTypeStateIssuer
100101583MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20211227000155 WI Practitioner - Clinical Social Worker 7911398144 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9818-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
US 2 Behavioral Health Care Inc CurrentSince Nov 17, 2021 Accepting new patients

Locations

119 N McCarthy Rd
Ste P
Appleton, WI 54913
Phone (920) 903-1060

4650 W Spencer St
Appleton, WI 54914
Phone (920) 903-1060

5750 W Grande Market Dr
#A
Appleton, WI 54913
Phone (920) 903-1060

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1508484833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 W SPENCER ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549149106",
            "telephone_number": "920-903-1060",
            "fax_number": "920-903-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SPENCER ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549149106",
            "telephone_number": "920-903-1060",
            "fax_number": "920-903-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARVEY",
        "first_name": "MCKENNA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-13",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9818-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100101583",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.