Individual provider Active NPI

Ivelisse Soto, LCSW

  • Clinical Social Worker
  • Waterbury, CT
National Provider Identifier
1023139599
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
006400 Issued in CT
Practice address
95 Thomaston Ave
Waterbury, CT 06702-1007
Phone
(203) 805-5378
NPI assigned
Apr 3, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 006400 CT Primary

Addresses

Primary practice location

95 Thomaston Ave
Waterbury, CT 06702-1007

Mailing address

95 Thomaston Ave
Waterbury, CT 06702-1007
Phone (203) 805-5378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080606000334 CT Practitioner - Clinical Social Worker 3274603931 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006400CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Jan 1, 2002 Accepting new patients
State of Connecticut CurrentSince Jan 1, 2002 Accepting new patients
Greenharmony Counseling, LCC Clinical Current Accepting new patients

Locations

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

55 W Main St
Ste 410
Waterbury, CT 06702
Phone (203) 805-6408

95 Thomaston Ave
Waterbury, CT 06702
Phone (203) 805-5300

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1023139599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 THOMASTON AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021007",
            "telephone_number": "203-805-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 THOMASTON AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021007",
            "telephone_number": "203-805-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOTO",
        "first_name": "IVELISSE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.