Individual provider Active NPI

Kristin Marie Redell, LCSW

  • Social Worker
  • Amherst, NY
National Provider Identifier
1477643716
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
072895 Issued in NY
Practice address
85 Bryant Woods S
Amherst, NY 14228-3604
Phone
(716) 689-3333
Fax
(716) 689-9695
NPI assigned
Oct 16, 2006
Last updated
Jul 6, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 072895 NY Primary

Addresses

Primary practice location

85 Bryant Woods S
Amherst, NY 14228-3604

Mailing address

85 Bryant Woods S
Amherst, NY 14228-3604
Phone (716) 689-3333

Other identifiers 2

IdentifierTypeStateIssuer
000506354006OtherNYCOMMUNITY BLUE
00030241501OtherNYUNIVERA

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20180124001106 NY Practitioner - Clinical Social Worker 9234498080 Practice locations: Amherst, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
072895NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Suburban Psychiatric Associates, LLP PastSince Apr 1, 1996 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309910400000",
    "number": "1477643716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 BRYANT WOODS S",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142283604",
            "telephone_number": "716-689-3333",
            "fax_number": "716-689-9695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 BRYANT WOODS S",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142283604",
            "telephone_number": "716-689-3333",
            "fax_number": "716-689-9695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDELL",
        "first_name": "KRISTIN",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2011-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "072895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY BLUE",
            "identifier": "000506354006",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00030241501",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amherst, NY

Sources for this page

Verify at the official NPI Registry.