Active NPI
Evelyn Diane Kirkman, LCSW
- Clinical Social Worker
- West Hartford, CT
National Provider Identifier
1407861867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 000108
- Practice address
- 68 S Main St
Suite 202
West Hartford, CT 06107-2445 - Phone
- (860) 521-7111
- Fax
- (860) 561-6184
- NPI assigned
- Jul 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 000108 | CT | Primary |
Addresses
Primary practice location
68 S Main St
Suite 202
West Hartford, CT 06107-2445
Mailing address
68 S Main St
Suite 202
West Hartford, CT 06107-2445
Phone (860) 521-7111
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140000108CT04 | Other | CT | ANTHEM BCBS PROVIDER # |
| 079556 | Other | CT | MHN PROVIDER # |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407861867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 S MAIN ST",
"address_2": "SUITE 202",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061072445",
"telephone_number": "860-521-7111",
"fax_number": "860-561-6184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "68 S MAIN ST",
"address_2": "SUITE 202",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061072445",
"telephone_number": "860-521-7111",
"fax_number": "860-561-6184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRKMAN",
"first_name": "EVELYN",
"middle_name": "DIANE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "000108",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS PROVIDER #",
"identifier": "140000108CT04",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN PROVIDER #",
"identifier": "079556",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.