Kathryn Ellen McCullough, LCSW

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CSW1628 Issued in RI

Practice address

825 Chalkstone Ave
Providence, RI 02908-4728

Phone

(401) 456-2000

Fax

(401) 456-6744

NPI assigned

Oct 19, 2016

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 RI

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmccullough@direct.carene.org

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.

• Prospect Chartercare RWMC, LLC

  • Internal Medicine Physician
  • Providence, RI
  • NPI 1285059287

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD
• Prospect Chartercare Sjhsri, LLC

  • Internal Medicine Physician
  • North Providence, RI
  • NPI 1588089759
  Medicare reassignment NPD
• Affinity Physicians LLC.

  • Internal Medicine Physician
  • Warwick, RI
  • NPI 1184944662
  NPD
• Prospect Chartercare RWMC, LLC

  • Cardiovascular Disease Physician
  • Providence, RI
  • NPI 1326463548
  NPD
• Prospect Chartercare Sjhsri, LLC

  • General Acute Care Hospital
  • North Providence, RI
  • NPI 1871918870
  NPD

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1578014098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 ROTH RD",
            "city": "DAYVILLE",
            "state": "CT",
            "postal_code": "062411416",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-6744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084728",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-6744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KATHRYN",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "RI",
            "license": "CSW1628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Kent McCrae Jr., MD
• Nicholas Montgomery McCrory, MD
• Rachel McCrystal, LICSW
• Emily R McCue, APRN,BC
• Judith McCullough Romero, PH.D.
• Kyle McCurdy, LMHC
• Cara McDavitt, MD
• Patricia McDermott, PA
• Daniel McDonald, CRNA
• Donna Marie McDonald, APRN

• Addiction (Substance Use Disorder) Counselor in Providence, RI
• Providers in Providence, RI by specialty
• Addiction (Substance Use Disorder) Counselor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.