Individual provider Active NPI

Sara Jane Kattirtzi, LCSW

  • Clinical Social Worker
  • Mystic, CT
National Provider Identifier
1366076861
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
009973 Issued in CT
Practice address
49 Whitehall Ave
Mystic, CT 06355-1966
Phone
(860) 961-5702
NPI assigned
Feb 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 009973 CT Primary

Addresses

Primary practice location

49 Whitehall Ave
Mystic, CT 06355-1966

Mailing address

217 Brickyard Rd
N Grosvenordl, CT 06255-1503
Phone (203) 218-3170

Other names 1

  • Ms. Sara Jane Senko Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009973CTMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1366076861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 BRICKYARD RD",
            "city": "N GROSVENORDL",
            "state": "CT",
            "postal_code": "062551503",
            "telephone_number": "203-218-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 WHITEHALL AVE",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551966",
            "telephone_number": "860-961-5702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATTIRTZI",
        "first_name": "SARA",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-24",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "009973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "SENKO",
            "middle_name": "JANE",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.