Cole Marvin, LCSW
Individual provider Active NPI Clinical Social Worker · Kent, IL
NPI 1942952304 · NPPES record last updated Jan 26, 2022
Key facts
- NPI
- 1942952304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149007305 (IL)
- Practice address
- 2255 N Kent Rd
Kent, IL 61044-9625 - Phone
- (815) 904-4604
- NPI assigned
- Jan 26, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149007305 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149007305 | IL | Yes |
Addresses
Primary practice location
2255 N Kent Rd
Kent, IL 61044-9625
Mailing address
2255 N Kent Rd
Kent, IL 61044-9625
Phone (815) 904-4604
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Kent |
Other providers in Kent, IL
All providers in Kent, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.