Kerry Ann Kruk-Borisov, LPC, ATR-BC, CSAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701005892 Issued in VA

Practice address

2200 Colonial Ave Ste 12
Norfolk, VA 23517-1919

Phone

(757) 937-5780

NPI assigned

Jul 14, 2016

Last updated

Oct 19, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Mental Health Counselor

Education

Eastern Virginia Medical School, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rewired Canvas Psychotherapy LLC

  • Professional Counselor
  • Norfolk, VA
  • NPI 1457171563
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1316390420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3140 HERBERT ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235132302",
            "telephone_number": "757-589-3498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 COLONIAL AVE STE 12",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171919",
            "telephone_number": "757-937-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUK-BORISOV",
        "first_name": "KERRY",
        "middle_name": "ANN",
        "credential": "LPC, ATR-BC, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-14",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0710102187",
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "VA",
            "license": "0701005892",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701005892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon G. Kramer, CPNP
• Kristin Diana Kreider, M.D.
• Sangeetha Krishnamoorthy, MD
• James Ellis Krochmal, DDS
• Brooke Taylor Krolewski, PHARM.D.
• Julie Anne Krumreich, MD
• Amy Michelle Krupa, DNP, APRN, ACCNS-P
• Jean Marie Krupinski
• Christina Krupski, PA-C
• Briana Krutsinger

• Professional Counselor in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.