Individual provider Active NPI

Kathy Lyn Vandoros, LSW

  • Social Worker
  • Kent, OH
National Provider Identifier
1720878705
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S6364 Issued in OH
Practice address
275 Martinel Dr
Kent, OH 44240-4380
Phone
(330) 673-6339
Fax
(330) 673-6441
NPI assigned
May 12, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X S6364 OH Primary

Addresses

Primary practice location

275 Martinel Dr
Kent, OH 44240-4380

Mailing address

275 Martinel Dr
Kent, OH 44240-4380
Phone (330) 673-6339

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

LicenseStateTypeSpecialty
S6364OHMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1747008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1720878705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 MARTINEL DR",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442404380",
            "telephone_number": "330-673-6339",
            "fax_number": "330-673-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 MARTINEL DR",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442404380",
            "telephone_number": "330-673-6339",
            "fax_number": "330-673-6441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDOROS",
        "first_name": "KATHY",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-12",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S6364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; 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.