NPIMap

Individual provider Active NPI

Kaitlyn Coral Marbaugh, CDCA, LSW

  • Social Worker
  • Lima, OH
National Provider Identifier
1962169730
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S.2309798 Issued in OH
Practice address
1235 W Market St
Lima, OH 45805-2728
Phone
(567) 289-6060
NPI assigned
Nov 29, 2021
Last updated
Sep 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.178596 OH
Social Worker 104100000X S.2309798 OH Primary

Addresses

Primary practice location

1235 W Market St
Lima, OH 45805-2728

Mailing address

1235 W Market St
Lima, OH 45805-2728
Phone (567) 259-8562

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL AOD Other
Other URL MentalHealth Direct

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

LicenseStateTypeSpecialty
CDCA.178596OHMDAddiction (Substance Use Disorder) Counselor
S.2309798OHMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Group Home, LLC Past Accepting new patients
Phoenix Group Home, LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/pathihc/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1962169730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 W MARKET ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458052728",
            "telephone_number": "567-259-8562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 W MARKET ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458052728",
            "telephone_number": "567-289-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARBAUGH",
        "first_name": "KAITLYN",
        "middle_name": "CORAL",
        "credential": "CDCA, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-29",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.178596",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2309798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AOD",
            "affiliation": "N",
            "endpointDescription": "AOD use",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Treatment",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "AOD",
            "address_1": "709 N Cable Rd",
            "city": "Lima",
            "state": "OH",
            "country_code": "US",
            "postal_code": "458051737",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "MentalHealth",
            "affiliation": "N",
            "endpointDescription": "Mentalhealth",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Treatment",
            "address_1": "1235 W Market St",
            "city": "Lima",
            "state": "OH",
            "country_code": "US",
            "postal_code": "458052728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lima, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; 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.