Kim Christine Roser-Kedward, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS22405 Issued in CA

Practice address

4075 Park Blvd
Ste 102-212
San Diego, CA 92103-2670

Phone

(619) 379-7450

NPI assigned

Feb 24, 2007

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

Other names 1

• Ms. Kim Christine Roser Former name

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

Specialty

Clinical Social Worker

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Jeanne M. Peterson, PH.D., Psychologist, Inc.

  • Psychologist
  • San Diego, CA
  • NPI 1417145079
  NPD (past)
• Joanna R Benavidez PHD Clinical Psychologist

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1962029371
  NPD (past)

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

{
    "created_epoch": "1172275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1750417952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16597",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921766441",
            "telephone_number": "619-379-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4075 PARK BLVD",
            "address_2": "STE 102-212",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032670",
            "telephone_number": "619-379-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSER-KEDWARD",
        "first_name": "KIM",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-24",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS22405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "ROSER",
            "middle_name": "CHRISTINE",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maryann Rosenthal, PH.D.
• Murray H Rosenthal, D.O., FAPA
• Sara G Rosenthal, M.D.
• Douglas Ryan Rosentrater, OTR/L
• Marlene L Rosenwald-Becker, NP
• Chammy Roses
• Jeanette Delos Reyes Rosete-Okamoto
• Denise Rosete, RBT
• Ivan Rosete
• Jazmin Roshan

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, 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 Aug 3, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.