Kathleen P Smith, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

90563 Issued in CA

Practice address

500 Chadbourne Rd FL 2
Fairfield, CA 94534-9645

Phone

(402) 439-4039

Fax

(402) 439-4035

NPI assigned

Jan 25, 2007

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 3

Medicare fee-for-service enrollment

Enrolled in CA

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

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.

• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Clinical

  Medicare reassignment NPD

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1710033691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 CHADBOURNE RD FL 2",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945349645",
            "telephone_number": "402-439-4039",
            "fax_number": "402-439-4035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CHADBOURNE RD FL 2",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945349645",
            "telephone_number": "402-439-4039",
            "fax_number": "402-439-4035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6901 N 72nd St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681221709",
            "country_code": "US",
            "telephone_number": "402-717-4673",
            "fax_number": "402-572-3472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATHLEEN",
        "middle_name": "P",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NE",
            "license": "542",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "90563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMSW",
            "identifier": "542",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "90563",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMHP",
            "identifier": "646",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaylynn Brozell Smith, RN
• Jeffrery Scott Smith, P.T.
• Jewell Juanita Smith
• Jocelyn Smith
• Kathleen Ann Smith
• Kayla Magnolia Smith
• Kimberly Ann Smith, PSYD
• Laneisha Smith
• Raymond Bernard Smith, ASW
• Reggie A Smith

• Clinical Social Worker in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; 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.