Kathleen Rose Mack, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9613-123 Issued in WI

Practice address

5555 N Port Washington Rd Ste 200
Glendale, WI 53217-4927

Phone

(262) 789-1191

NPI assigned

Feb 17, 2021

Sex

Female

Sole proprietor

No

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 WI

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: lifestancehealth.kathleenmack@149809.advancedmd-direct.com

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.

• Cornerstone Counseling Services, Inc

  • Mental Health Counselor
  • Brookfield, WI
  • NPI 1033127246
  Medicare reassignment NPD

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

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1619560992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2459 N 83RD ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532131024",
            "telephone_number": "414-507-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 N PORT WASHINGTON RD STE 200",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174927",
            "telephone_number": "262-789-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KATHLEEN",
        "middle_name": "ROSE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9613-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica of America Inc.
• Luxottica of America Inc.
• Valerie B. Lyon, MD
• Leila Maadooliat
• Lawrence John Maciolek, M.D.
• Mackenzie Harris
• Bridget Mackey, DDS
• Magnolia Voice and Swallowing Specialists, LLC
• Paul D Mandel, M.D.
• Leeann Mansker, RN

• Clinical Social Worker in Glendale, WI
• Providers in Glendale, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; 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.