NPIMap

Organization Active NPI

Psychotherapy Resources of Norfolk LTD

  • Clinical Social Worker
  • Norfolk, VA
National Provider Identifier
1316947328
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904000234 Issued in VA
Legal business name
PSYCHOTHERAPY RESOURCES OF NORFOLK LTD
Practice address
1709 Colley Ave
Suite 312
Norfolk, VA 23517-1675
Phone
(757) 640-0400
Fax
(757) 640-0497
NPI assigned
Aug 1, 2005
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Betty Alexandra Kedrock, LCSWNPI 1275533796
Title
President
Phone
(757) 640-0400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 4274 VA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 4274 VA
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 4274 VA
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 0904000234 VA Primary

Addresses

Primary practice location

1709 Colley Ave
Suite 312
Norfolk, VA 23517-1675

Mailing address

1709 Colley Ave
Suite 312
Norfolk, VA 23517-1675
Phone (757) 640-0400

Other identifiers 3

IdentifierTypeStateIssuer
314544OtherVATRICARE
098384OtherVABCBS
049956OtherVABCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422000546 VA Part B Supplier - Clinic/Group Practice 7911993217 Receives reassigned benefits from 3 practitioners
Practice locations: Charlottesville, VA

National Provider Directory

National Provider Directory

Locations

1108 East Market St
Charlottesville, VA 22902
Phone (434) 296-2350

1709 Colley Ave
Ste 312
Norfolk, VA 23517
Phone (757) 640-0400

330 W Brambleton Ave
Ste 206
Norfolk, VA 23510
Phone (757) 640-0400

Practitioners & affiliated clinicians

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1316947328",
    "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": {
        "organization_name": "PSYCHOTHERAPY RESOURCES OF NORFOLK LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-01",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "KEDROCK",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "ALEXANDRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-640-0400",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "4274",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "4274",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "4274",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904000234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "314544",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "098384",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "049956",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.