Old Town Counseling of Newburgh LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

OLD TOWN COUNSELING OF NEWBURGH LLC

Practice address

4333 Old State Route 261
Newburgh, IN 47630-2652

Phone

(507) 491-8887

NPI assigned

Jul 9, 2021

Organization subpart

No

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

Authorized official

Name

Kelly Kopatich, LCSWNPI 1619324910

Title

Owner

Phone

(507) 491-8887

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly M Kopatich, LCSW

  • Clinical Social Worker
  • Newburgh, IN
  • NPI 1619324910
  NPD Authorized official

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

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1891366936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1114",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476291114",
            "telephone_number": "507-491-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4333 OLD STATE ROUTE 261",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302652",
            "telephone_number": "507-491-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN COUNSELING OF NEWBURGH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-09",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "KOPATICH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-491-8887",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "34008915A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "8126020313",
            "affiliation": "N",
            "endpointDescription": "fax",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4333 Old State Route 261",
            "city": "Newburgh",
            "state": "IN",
            "country_code": "US",
            "postal_code": "476302652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Newburgh, IN
• Providers in Newburgh, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; 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.