Provider Demographics
NPI:1497292338
Name:CANFIELD, KARA (LCSW)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 MOUNTVILLE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1424
Mailing Address - Country:US
Mailing Address - Phone:937-247-4747
Mailing Address - Fax:
Practice Address - Street 1:3117 MOUNTVILLE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-1424
Practice Address - Country:US
Practice Address - Phone:937-724-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600409101YM0800X, 104100000X
OHI.19019621041C0700X
DEQ1-00118141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-0693OtherCARF CERTIFICATION
OH0074861OtherMEDICAID-ODADAS
OHH130910OtherMEDICARE GROUP PTAN
OH0074946OtherMEDICAID-ODMH