Kim Shepardson Watson, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

002624 Issued in CT

Practice address

29 Chesterfield Rd
East Lyme, CT 06333

Phone

(860) 739-6974

Fax

(860) 739-5290

NPI assigned

Sep 1, 2006

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 1

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

Specialty

Clinical Social Worker

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Summit Counseling LLC

  • Community/Behavioral Health Agency
  • Preston, CT
  • NPI 1871874537
  NPD (past)

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315785600000",
    "number": "1164534384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "06333",
            "telephone_number": "860-739-6974",
            "fax_number": "860-739-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 CHESTERFIELD RD",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "06333",
            "telephone_number": "860-739-6974",
            "fax_number": "860-739-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARDSON WATSON",
        "first_name": "KIM",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2011-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CT",
            "license": "002624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004255875",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sam-Car LLC
• Jill C Sandora
• Fred E Santoro, M.D.
• Jessica Sedita-Gatto, N.D.
• Gerald L. Shaw, M.D.
• Shoreline Physical Therapy, LLC
• Shoreline Shine LLC
• Paris Ann Silvestri, LCSW
• Michael A. Simeone, O.D.
• Simply Healing

• Social Worker in East Lyme, CT
• Providers in East Lyme, CT by specialty
• Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.