Kathleen C. Derise, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904000534 Issued in VA

Practice address

12695 McManus Blvd
BLDG. 8
Newport News, VA 23602-4435

Phone

(757) 877-7700

NPI assigned

Aug 10, 2006

Last updated

Jul 8, 2007By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629089248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 LAKEWOOD PARK DR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236026261",
            "telephone_number": "757-877-8765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12695 MCMANUS BLVD",
            "address_2": "BLDG. 8",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024435",
            "telephone_number": "757-877-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERISE",
        "first_name": "KATHLEEN",
        "middle_name": "C.",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904000534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Newport News, VA
• Providers in Newport News, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.