Basic Information
Provider Information
NPI: 1003805920
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JAMES
FirstName: KATHY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 611 LINCOLNWAY E
Address2:  
City: SOUTH BEND
State: IN
PostalCode: 466013220
CountryCode: US
TelephoneNumber: 5742322255
FaxNumber: 5742328968
Practice Location
Address1: 611 LINCOLNWAY E
Address2:  
City: SOUTH BEND
State: IN
PostalCode: 466013220
CountryCode: US
TelephoneNumber: 5742322255
FaxNumber: 5742328968
Other Information
ProviderEnumerationDate: 10/14/2005
LastUpdateDate: 02/11/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X34004497AINY Behavioral Health & Social Service ProvidersSocial WorkerClinical

ID Information
IDTypeStateIssuerDescription
00000038925401INANTHEMOTHER
00000038925401INUNICAREOTHER
232886701INCIGNAOTHER


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