Kathryn L Revtyak, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

39461 Issued in TX

Practice address

905 Noble St
El Paso, TX 79902-4739

Phone

(915) 247-6679

Fax

(915) 503-2187

NPI assigned

Jul 7, 2011

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Childrens Grief Center of El Paso

  • Mental Health Counselor
  • El Paso, TX
  • NPI 1154127470

  Clinical

  NPD

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309996800000",
    "number": "1821385071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 NOBLE ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799024739",
            "telephone_number": "915-247-6679",
            "fax_number": "915-503-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 NOBLE ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799024739",
            "telephone_number": "915-247-6679",
            "fax_number": "915-503-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVTYAK",
        "first_name": "KATHRYN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "39461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodolfo Manuel Revilla
• Revive Global PLLC
• Revive Home Care Inc.
• Revive Home Care Inc.
• Revive Medical, PLLC
• Beatriz Rey Garcia
• Briana Lauren Rey Kolstad, PC PNP
• Alyssa Michelle Rey
• Eduardo Jesus Rey Jr.
• Gabriela Rey, DDS

• Clinical Social Worker in El Paso, TX
• Providers in El Paso, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; 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.