Kelly M Kopatich, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34008915A Issued in IN

Practice address

Old Towne Counseling of Newburgh, LLC
4333 Old State Road 261
Newburgh, IN 47630-2655

Phone

(507) 491-8887

NPI assigned

May 17, 2016

Last updated

Dec 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Old Town Counseling of Newburgh LLC

  • Clinical Social Worker
  • Newburgh, IN
  • NPI 1891366936
  NPD Authorized official
• Good Samaritan Hospital

  • General Acute Care Hospital
  • Vincennes, IN
  • NPI 1225032881
  NPD (past)

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1619324910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4333 OLD STATE RD 261",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302655",
            "telephone_number": "507-491-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "OLD TOWNE COUNSELING OF NEWBURGH, LLC",
            "address_2": "4333 OLD STATE ROAD 261",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302655",
            "telephone_number": "507-491-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPATICH",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-17",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34008915A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Knight
• Manga Devi Kodali, M.D.
• Lindsey A Koester, PHARM D
• Taylor Jean Koester, FNP-C
• Miranda J Kolley, MSOTR/L CLT
• Stephen Mark Kopta, PH.D.
• Jamie Kostrzebski, OT
• Katherine Elizabeth Kote, APN, MSN, NNP-BC
• Mary Elizabeth Copeland Kozak, DO
• Paul Kozak, DO

• Clinical Social Worker in Newburgh, IN
• Providers in Newburgh, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.