Betty Alexandra Kedrock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904000234 Issued in VA

Practice address

1709 Colley Ave
Suite 312
Norfolk, VA 23517-1675

Phone

(757) 640-0400

Fax

(757) 640-0497

NPI assigned

Jul 27, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in VA

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, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychotherapy Resources of Norfolk LTDGroup PAC ID 7911993217, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Psychotherapy Resources of Norfolk LTD

  • Clinical Social Worker
  • Norfolk, VA
  • NPI 1316947328
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275533796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 COLLEY AVE",
            "address_2": "SUITE 312",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171675",
            "telephone_number": "757-640-0400",
            "fax_number": "757-640-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 COLLEY AVE",
            "address_2": "SUITE 312",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171675",
            "telephone_number": "757-640-0400",
            "fax_number": "757-640-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEDROCK",
        "first_name": "BETTY",
        "middle_name": "ALEXANDRA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904000234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8908478",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "A163599",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA",
            "identifier": "080436",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED HEALTH NETWORK",
            "identifier": "324004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COM PSYCH",
            "identifier": "247697",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "049958",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCH",
            "identifier": "216188",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5264256",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTION",
            "identifier": "028883",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kayton, PNP
• Mikaela Kcomt Lam, MD
• Tanika Janae Keagle, AGPCNP
• Haley Kearns, MD
• Tatiana Borisovna Keck, MD
• Carolyn Lee Kee
• Tiffany Keel
• Denise Keeley, LCSW
• Candice R Keen, PA
• David H Keenan, MSW EDD

• Clinical Social Worker in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.