Active NPI
Kathy Ann Mock, LCSW
- Clinical Social Worker
- Cary, NC
National Provider Identifier
1982922548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C006589
- Practice address
- 109 Fountain Brook Circle
Suite C
Cary, NC 27511 - Phone
- (919) 762-7857
- Fax
- (919) 714-8399
- NPI assigned
- May 6, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C006589 | NC | Primary |
Addresses
Primary practice location
109 Fountain Brook Circle
Suite C
Cary, NC 27511
Mailing address
2520 Pleasant Rd
Fuquay Varina, NC 27526-9460
Phone (919) 762-7857
Other practice location 1
217 Old Grove Ln
Apex, NC 27502-7005
Phone (919) 449-4313
Other practice location 2
602 E Academy St Ste 106
Fuquay Varina, NC 27526-2382
Phone (919) 762-7857
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6007501 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C006589 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1982922548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2520 PLEASANT RD",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275269460",
"telephone_number": "919-762-7857",
"fax_number": "919-714-8399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 FOUNTAIN BROOK CIRCLE",
"address_2": "SUITE C",
"city": "CARY",
"state": "NC",
"postal_code": "27511",
"telephone_number": "919-762-7857",
"fax_number": "919-714-8399"
}
],
"practiceLocations": [
{
"address_1": "217 Old Grove Ln",
"address_purpose": "LOCATION",
"city": "Apex",
"state": "NC",
"postal_code": "275027005",
"country_code": "US",
"telephone_number": "919-449-4313",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "602 E Academy St Ste 106",
"address_purpose": "LOCATION",
"city": "Fuquay Varina",
"state": "NC",
"postal_code": "275262382",
"country_code": "US",
"telephone_number": "919-762-7857",
"fax_number": "919-714-8399",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOCK",
"first_name": "KATHY",
"middle_name": "ANN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C006589",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6007501",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.