Mirta I Kaperonis, LCSW

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LCSW-10019 Issued in AZ

Practice address

30 Acoma Blvd S
Suite101-103
Lake Havasu City, AZ 86403-5957

Phone

(928) 680-0604

Fax

(928) 680-0605

NPI assigned

May 19, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mediterranean Mental Health Center, Inc.

  • Psychiatry Physician
  • Lake Havasu City, AZ
  • NPI 1619903986
  NPD (past)

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242691200000",
    "number": "1689809600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 ACOMA BLVD S",
            "address_2": "SUITE 101-103",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035957",
            "telephone_number": "928-680-0604",
            "fax_number": "928-680-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 ACOMA BLVD S",
            "address_2": "SUITE101-103",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035957",
            "telephone_number": "928-680-0604",
            "fax_number": "928-680-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPERONIS",
        "first_name": "MIRTA",
        "middle_name": "I",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-19",
        "last_updated": "2009-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AZ",
            "license": "LCSW-10019",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LASAC-13100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "LCSW-10019",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "LASAC-13100",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kaley
• Gene Kalin, M.D.
• Daryl John Kallenbach, CNA
• Jamie N Kamon-Brancazio, PT, DPT
• Carrie Jean Kane, LPC
• Vasilios W Kaperonis, M.D.
• Katalin H Boleratzky MD Inc
• Ashutosh Kaushesh, D.D.S.
• Tod Dempsey Keam, O.T.R.
• Jennifer Keele, LMT

• Counselor in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; 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.