Kathleen Mary Deroche, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

101 N Virginia St
Suite 105
Crystal Lake, IL 60014-3426

Phone

(815) 477-4024

Fax

(815) 477-4034

NPI assigned

Jul 19, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Clinical Social Worker

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Horizons Behavioral Health LLCGroup PAC ID 4385531672, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Horizons Behavioral Health LLC

  • Social Worker
  • Crystal Lake, IL
  • NPI 1881692689
  Medicare reassignment Care Compare group NPD
• Blair Counseling and Mediation PC

  • Professional Counselor
  • Crystal Lake, IL
  • NPI 1245479674
  Medicare reassignment NPD

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187136000000",
    "number": "1528067824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N VIRGINIA ST",
            "address_2": "SUITE 105",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143426",
            "telephone_number": "815-477-4024",
            "fax_number": "815-477-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N VIRGINIA ST",
            "address_2": "SUITE 105",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143426",
            "telephone_number": "815-477-4024",
            "fax_number": "815-477-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROCHE",
        "first_name": "KATHLEEN",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2007-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.