Active NPI
Caroline Penberthy, M.S.W., L.C.S.W.
- Clinical Social Worker
- Kirkwood, MO
National Provider Identifier
1639160062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW000802
- Practice address
- 12166 Old Big Bend Rd
Suite 100
Kirkwood, MO 63122-6844 - Phone
- (314) 909-0211
- Fax
- (314) 909-0323
- NPI assigned
- Nov 3, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW000802 | MO | Primary |
Addresses
Primary practice location
12166 Old Big Bend Rd
Suite 100
Kirkwood, MO 63122-6844
Mailing address
12166 Old Big Bend Rd
Suite 100
Kirkwood, MO 63122-6844
Phone (314) 909-0211
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 472758 | Other | MO | HEALTHLINK |
| R01055 | Other | MO | MERCY HEALTH PLANS |
| 6236004 | Other | MO | UNITED BEHAVIORAL HEALTH |
| 125668 | Other | MO | BLUE CROSS BLUE SHIELD |
| O62230 | Other | MO | EXCLUSIVE CHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW000802 | MO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-County Physicians, Inc. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Kirkwood, MO
- NPI 1184764904
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1639160062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12166 OLD BIG BEND RD",
"address_2": "SUITE 100",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226844",
"telephone_number": "314-909-0211",
"fax_number": "314-909-0323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12166 OLD BIG BEND RD",
"address_2": "SUITE 100",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226844",
"telephone_number": "314-909-0211",
"fax_number": "314-909-0323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENBERTHY",
"first_name": "CAROLINE",
"credential": "M.S.W., L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "SW000802",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "472758",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY HEALTH PLANS",
"identifier": "R01055",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "6236004",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "125668",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EXCLUSIVE CHOICE",
"identifier": "O62230",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.