Individual provider Active NPI

Kristen Sidwell, LCSW

  • Clinical Social Worker
  • Bradenton, FL
National Provider Identifier
1922838846
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW-19285 Issued in FL
Practice address
4835 27TH St W Ste 125
Bradenton, FL 34207-1759
Phone
(941) 753-0064
NPI assigned
Aug 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW-19285 FL Primary

Addresses

Primary practice location

4835 27TH St W Ste 125
Bradenton, FL 34207-1759

Mailing address

173 Holly Bank Ave
Nokomis, FL 34275-3783
Phone (660) 815-1728

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20240822001339 FL Practitioner - Clinical Social Worker 6204375249 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Debra K Carter PH D and Associates PAGroup PAC ID 0547234379, 9 clinicians

Practice addresses (Care Compare)

4835 27TH St W
Suite 125
Bradenton, FL 34207-1759
Phone (941) 753-0064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW-19285FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Debra K Carter PH D & Associates PA CurrentSince Sep 4, 2024 Accepting new patients

Locations

4835 27th St W
Ste 125
Bradenton, FL 34207
Phone (941) 753-0064

Networks

  • Freedom Health HMO Network

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1922838846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 HOLLY BANK AVE",
            "city": "NOKOMIS",
            "state": "FL",
            "postal_code": "342753783",
            "telephone_number": "660-815-1728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 27TH ST W STE 125",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342071759",
            "telephone_number": "941-753-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDWELL",
        "first_name": "KRISTEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW-19285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.