Active NPI
Stacey Kim, LSW
- Social Worker
- Bloomington, IN
National Provider Identifier
1841525565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 33005674A
- Practice address
- 600 N Jordan Ave
Indiana University Counseling and Psychological Service
Bloomington, IN 47405-3190 - Phone
- (812) 855-5711
- Fax
- (812) 855-8447
- NPI assigned
- Oct 14, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 33005674A | IN | Primary |
Addresses
Primary practice location
600 N Jordan Ave
Indiana University Counseling and Psychological Service
Bloomington, IN 47405-3190
Mailing address
600 N Jordan Ave
Indiana University Counseling and Psychological Service
Bloomington, IN 47405-3190
Phone (812) 855-5711
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
| License | State | Type | Specialty |
|---|---|---|---|
| 33005674A | IN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255478400000",
"number": "1841525565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 N JORDAN AVE",
"address_2": "INDIANA UNIVERSITY COUNSELING AND PSYCHOLOGICAL SERVICE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474053190",
"telephone_number": "812-855-5711",
"fax_number": "812-855-8447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N JORDAN AVE",
"address_2": "INDIANA UNIVERSITY COUNSELING AND PSYCHOLOGICAL SERVICE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474053190",
"telephone_number": "812-855-5711",
"fax_number": "812-855-8447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "STACEY",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-14",
"last_updated": "2009-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "33005674A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.