Individual provider Active NPI

Kerry Litke, LCSW

  • Clinical Social Worker
  • Essex, CT
National Provider Identifier
1215230677
Registry record updated May 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8327 Issued in CT
Practice address
190 Westbrook Rd
Essex, CT 06426-1518
Phone
(860) 767-0147
Fax
(860) 767-0148
NPI assigned
Dec 7, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Clinical Social Worker 1041C0700X 8327 CT Primary

Addresses

Primary practice location

190 Westbrook Rd
Essex, CT 06426-1518

Mailing address

255 Hempstead St
New London, CT 06320-6204

Other practice location 1

75 Granite St
New London, CT 06320-5730
Phone (860) 437-4550

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
I20190628000462 CT Practitioner - Clinical Social Worker 3476887290 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Child and Family Agency of Southeastern Connecticut, Inc. CurrentSince May 9, 2019 Accepting new patients
Child and Family Agency of Southeastern Connecticut, Inc. CurrentSince May 9, 2019 Accepting new patients
Child and Family Agency of Southeastern Connecticut, Inc. Past Accepting new patients
Child and Family Agency of Southeastern Connecticut, Inc. Past Accepting new patients

Locations

591 Poquonnock Rd
Groton, CT 06340
Phone (860) 449-8217

255 Hempstead St
New London, CT 06320

4 Grove Beach Rd N
Ste 2D
Westbrook, CT 06498

Organizations & group practices 4

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": "1291680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1215230677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063206204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 WESTBROOK RD",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261518",
            "telephone_number": "860-767-0147",
            "fax_number": "860-767-0148"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Granite St",
            "address_purpose": "LOCATION",
            "city": "New London",
            "state": "CT",
            "postal_code": "063205730",
            "country_code": "US",
            "telephone_number": "860-437-4550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LITKE",
        "first_name": "KERRY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-07",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "8327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Essex, CT

Sources for this page

Verify at the official NPI Registry.