Individual provider Active NPI

Kenneth James Mancini, LMSW

  • Clinical Social Worker
  • Ypsilanti, MI
National Provider Identifier
1609169531
Registry record updated May 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801091076 Issued in MI
Practice address
555 Towner St
Ypsilanti, MI 48198-5752
Phone
(734) 544-3000
Fax
(734) 544-2906
NPI assigned
May 25, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2011

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 6801091076 MI Primary

Addresses

Primary practice location

555 Towner St
Ypsilanti, MI 48198-5752

Mailing address

555 Towner St
PO Box 915
Ypsilanti, MI 48198-5752
Phone (734) 544-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20130826001113 MI Practitioner - Clinical Social Worker 8729221510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of MacombGroup PAC ID 4880581404, 81 clinicians

Practice addresses (Care Compare)

43740 N Groesbeck Hwy
Clinton Township, MI 48036-1139
Phone (586) 469-7229

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
County of Macomb CurrentSince May 4, 2013 Accepting new patients
County of Macomb CurrentSince May 4, 2013 Accepting new patients

Locations

22550 Hall Rd
Clinton Twp, MI 48036
Phone (586) 441-3884

19800 Hall Rd
Clinton Twp, MI 48038
Phone (586) 854-4804

43740 N Groesbeck Hwy
Clinton Twp, MI 48036
Phone (586) 469-7229

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1306281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306281600000",
    "number": "1609169531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 TOWNER ST",
            "address_2": "PO BOX 915",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481985752",
            "telephone_number": "734-544-3000",
            "fax_number": "734-544-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 TOWNER ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481985752",
            "telephone_number": "734-544-3000",
            "fax_number": "734-544-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCINI",
        "first_name": "KENNETH",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-25",
        "last_updated": "2011-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801091076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.