Organization Active NPI

Kimberly J. Carr, L.C.S.W., P.C.

  • Clinical Social Worker
  • Woodbridge, VA
National Provider Identifier
1083959456
Registry record updated Dec 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904001689 Issued in VA
Legal business name
KIMBERLY J. CARR, L.C.S.W., P.C.
Practice address
13164 Centerpointe Way
Suite 202
Woodbridge, VA 22193-5288
Phone
(703) 897-8970
Fax
(703) 897-9732
NPI assigned
Dec 11, 2012
Last updated
Dec 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2012

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

Authorized official

Name
Ms. Kimberly Jo Carr, L.C.S.W.NPI 1033304670
Title
Director
Phone
(703) 897-8970

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904001689 VA Primary

Addresses

Primary practice location

13164 Centerpointe Way
Suite 202
Woodbridge, VA 22193-5288

Mailing address

13164 Centerpointe Way
Suite 202
Woodbridge, VA 22193-5288
Phone (703) 897-8970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130124000290 VA Part B Supplier - Clinic/Group Practice 6800040999 Receives reassigned benefits from 1 practitioner
Practice locations: Manassas, VA

National Provider Directory

National Provider Directory

Locations

4349 Ridgewood Center Dr
#1
Woodbridge, VA 22192
Phone (703) 309-6416

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355184000000",
    "number": "1083959456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13164 CENTERPOINTE WAY",
            "address_2": "SUITE 202",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221935288",
            "telephone_number": "703-897-8970",
            "fax_number": "703-897-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13164 CENTERPOINTE WAY",
            "address_2": "SUITE 202",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221935288",
            "telephone_number": "703-897-8970",
            "fax_number": "703-897-9732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY J. CARR, L.C.S.W., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2012-12-11",
        "status": "A",
        "authorized_official_last_name": "CARR",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-897-8970",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904001689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.