Active NPI
Kerry Lassen, L.C.S.W
- Clinical Social Worker
- Shelton, CT
National Provider Identifier
1477515823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 005707
- Practice address
- 2 Trap Falls Rd Ste 120
Shelton, CT 06484 - Phone
- (203) 816-6424
- NPI assigned
- Apr 3, 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 | 005707 | CT | Primary |
Addresses
Primary practice location
2 Trap Falls Rd Ste 120
Shelton, CT 06484
Mailing address
29 Mesa Dr
Bethany, CT 06524-3093
Phone (203) 641-6090
Other practice location 1
1129 Essex Pl
Stratford, CT 06615-5850
Phone (203) 375-8050
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42-1643030 | Other | CT | MULTIPLAN |
| 004247088 | Medicaid | CT | |
| 339452 | Other | CT | MHN |
| 140005707CT01 | Other | CT | ANTHEM |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 005707 | CT | MD | Dental Hygienist |
| 5707 | CT | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573084800000",
"number": "1477515823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 MESA DR",
"city": "BETHANY",
"state": "CT",
"postal_code": "065243093",
"telephone_number": "203-641-6090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 TRAP FALLS RD STE 120",
"city": "SHELTON",
"state": "CT",
"postal_code": "06484",
"telephone_number": "203-816-6424"
}
],
"practiceLocations": [
{
"address_1": "1129 Essex Pl",
"address_purpose": "LOCATION",
"city": "Stratford",
"state": "CT",
"postal_code": "066155850",
"country_code": "US",
"telephone_number": "203-375-8050",
"fax_number": "203-375-8050",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LASSEN",
"first_name": "KERRY",
"credential": "L.C.S.W",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-03",
"last_updated": "2019-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "005707",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "42-1643030",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004247088",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "339452",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "140005707CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.