Active NPI
Kelvin L Mitchell, LCSW-C
- Clinical Social Worker
- Glenn Dale, MD
National Provider Identifier
1942431176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 15294
- Practice address
- 12150 Annapolis Rd Ste 104
Glenn Dale, MD 20769-9183 - Phone
- (301) 821-7716
- Fax
- (301) 352-0405
- NPI assigned
- Aug 5, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC50078802 | DC | |
| Clinical Social Worker | 1041C0700X | 15294 | MD | Primary |
| Community/Behavioral Health Agency | 251S00000X | LC50078802 | DC |
Addresses
Primary practice location
12150 Annapolis Rd Ste 104
Glenn Dale, MD 20769-9183
Mailing address
11205 Westport Dr
Bowie, MD 20720-3411
Phone (301) 821-7716
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 024330200 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC50078802 | DC | MD | Community/Behavioral Health Agency |
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": "1249430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271635200000",
"number": "1942431176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11205 WESTPORT DR",
"city": "BOWIE",
"state": "MD",
"postal_code": "207203411",
"telephone_number": "301-821-7716",
"fax_number": "301-352-0405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12150 ANNAPOLIS RD STE 104",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699183",
"telephone_number": "301-821-7716",
"fax_number": "301-352-0405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "KELVIN",
"middle_name": "L",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-05",
"last_updated": "2010-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC50078802",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "15294",
"primary": true
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "DC",
"license": "LC50078802",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "024330200",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glenn Dale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; 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.