1245766062 NPI number — KRISTEN M KOTHEIMER MSW, LISW-S

Table of content: KRISTEN M KOTHEIMER MSW, LISW-S (NPI 1245766062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245766062 NPI number — KRISTEN M KOTHEIMER MSW, LISW-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTHEIMER
Provider First Name:
KRISTEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LISW-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245766062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2980 BELMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44505-1834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-759-0276
Provider Business Mailing Address Fax Number:
330-759-0030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 YOUNGSTOWN POLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRUTHERS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44471-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-318-3078
Provider Business Practice Location Address Fax Number:
234-855-1072
Provider Enumeration Date:
05/11/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I.2002411-SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: S.1302238 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)