Krystal Marie Boothe, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW71811 Issued in CA

Practice address

117 E Colorado Blvd
Pasadena, CA 91105-1938

Phone

(661) 402-1545

Fax

(661) 727-0006

NPI assigned

Feb 19, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA, TX2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wings of the Future NFPGroup PAC ID 7416391404, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

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.

• Wings of the Future, NFP

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1194481556

  CA

  Medicare reassignment Care Compare group NPD Authorized official
• Wings of the Future Consulting Private Practice

  • Clinical Social Worker
  • Pasadena, CA
  • NPI 1649944430
  NPD Authorized official
• Wings of the Future Private Practice LCSW PC

  • Clinical Social Worker
  • Pasadena, CA
  • NPI 1144705724
  NPD Authorized official
• Darrell Broaddus Psychological Services PC

  • Clinical Psychologist
  • Orangevale, CA
  • NPI 1215339650
  NPD (past)

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1043488414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 ISLAND VISTA DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760051375",
            "telephone_number": "310-621-0150",
            "fax_number": "661-727-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E COLORADO BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911051938",
            "telephone_number": "661-402-1545",
            "fax_number": "661-727-0006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 LAKES DR",
            "address_purpose": "LOCATION",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902924",
            "country_code": "US",
            "telephone_number": "310-621-0150",
            "fax_number": "661-727-0006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTHE",
        "first_name": "KRYSTAL",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-19",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW71811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "9999999999",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99999999999999",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate Pomerantz Bono, MSW
• Jeremy Louis Bonwell
• Devin Boone
• Gwendolyn Meredith Booth, RN
• Scott Patrick Booth, RADTI
• Matthew Linden Borba, PH.D.
• Susan Borck
• Betty Borden Miller, PH.D.
• Morgan Borden, DO
• Mary Jane Borinaga, PT

• Clinical Social Worker in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.