Active NPI
Kelly Lynne Pietruch, LMSW
- Social Worker
- Utica, NY
National Provider Identifier
1194435909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 095973-1
- Practice address
- 430 Court St
Utica, NY 13502-4289 - Phone
- (315) 409-5456
- NPI assigned
- Dec 2, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 095973-1 | NY | Primary |
Addresses
Primary practice location
430 Court St
Utica, NY 13502-4289
Mailing address
11 Brainard St
Whitesboro, NY 13492-1511
Phone (315) 790-0529
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 095973-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669939200000",
"number": "1194435909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 BRAINARD ST",
"city": "WHITESBORO",
"state": "NY",
"postal_code": "134921511",
"telephone_number": "315-790-0529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 COURT ST",
"city": "UTICA",
"state": "NY",
"postal_code": "135024289",
"telephone_number": "315-409-5456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PIETRUCH",
"first_name": "KELLY",
"middle_name": "LYNNE",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-02",
"last_updated": "2022-12-02",
"certification_date": "2022-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "095973-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Utica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.