Individual provider Active NPI

Kathryn Malbica

  • Clinical Social Worker
  • Fayetteville, AR
National Provider Identifier
1619128642
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
13301-C Issued in AR
Practice address
1 W Sunbridge Dr
Fayetteville, AR 72703-1825
Phone
(479) 443-5575
Fax
(479) 443-9554
NPI assigned
Oct 8, 2008
Last updated
Sep 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 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 13301-C AR Primary

Addresses

Primary practice location

1 W Sunbridge Dr
Fayetteville, AR 72703-1825

Mailing address

1 W Sunbridge Dr
Fayetteville, AR 72703-1825
Phone (479) 443-5575

Other practice location 1

86 W Sunbridge Dr
Fayetteville, AR 72703-1822
Phone (479) 443-5575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20250115004089 AR Practitioner - Clinical Social Worker 0345778528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1 W Sunbridge Dr
Fayetteville, AR 72703-1825
Phone 47944355751030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Life Journey Counseling LLC Clinical CurrentSince Nov 7, 2024 Accepting new patients
Empowerment Counseling Services Past Accepting new patients

Locations

1 W Sunbridge Dr
Fayetteville, AR 72703
Phone (479) 443-5575

86 W Sunbridge Dr
Fayetteville, AR 72703
Phone (479) 435-6360

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, 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": "1223424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1619128642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031825",
            "telephone_number": "479-443-5575",
            "fax_number": "479-443-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031825",
            "telephone_number": "479-443-5575",
            "fax_number": "479-443-9554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "86 W Sunbridge Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727031822",
            "country_code": "US",
            "telephone_number": "479-443-5575",
            "fax_number": "479-443-9554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALBICA",
        "first_name": "KATHRYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-08",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "13301-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.