Crystal Mackinnon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

008709 Issued in CT

Practice address

428 Long Hill Rd Ste 201
Groton, CT 06340-3811

Phone

(860) 333-8765

Fax

(833) 204-4896

NPI assigned

Aug 8, 2011

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 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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Hope & Resiliency Counseling LLC

  • Clinical Social Worker
  • Groton, CT
  • NPI 1013547694
  Medicare reassignment NPD
• United Services Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dayville, CT
  • NPI 1063413011
  Medicare reassignment NPD

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

{
    "created_epoch": "1312761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1275812372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 LONG HILL RD STE 201",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403811",
            "telephone_number": "860-333-8765",
            "fax_number": "833-204-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 LONG HILL RD STE 201",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403811",
            "telephone_number": "860-333-8765",
            "fax_number": "833-204-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKINNON",
        "first_name": "CRYSTAL",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-08",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040400564",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christie Lee Lunny, COTA/L
• Luxottica of America Inc.
• Lydia P Perry LPC Ladc
• Thomas Joseph Maciolek, PH.D.
• Jennifer Lee Mackey, D.M.D.
• Theologos Ted Malahias, D.D.S
• Christine M Malcom, P.T.
• John Anthony Maldonado-Rivera
• Parris Malhoit
• Mark Mammoth

• Clinical Social Worker in Groton, CT
• Providers in Groton, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; 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.