Kenyatta Tolbert, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10415 Issued in CT

Practice address

475 Clinton Ave
Bridgeport, CT 06605-1700

Phone

(203) 368-4291

Fax

(203) 368-9167

NPI assigned

Nov 5, 2018

Last updated

Nov 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Connecticut Renaissance, Inc.Group PAC ID 0941253728, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Stamford, CT
  • NPI 1700893807
  Medicare reassignment Care Compare group
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waterbury, CT
  • NPI 1700352721
  NPD
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bridgeport, CT
  • NPI 1720130362
  NPD
• Connecticut Renaissance, Inc

  dba CT Renaissance

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norwalk, CT
  • NPI 1265449359
  NPD (past)

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

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541376000000",
    "number": "1497223887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 CLINTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051700",
            "telephone_number": "203-368-4291",
            "fax_number": "203-368-9167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 CLINTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051700",
            "telephone_number": "203-368-4291",
            "fax_number": "203-368-9167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLBERT",
        "first_name": "KENYATTA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-05",
        "last_updated": "2018-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "10415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004069985",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janelle Titus, LPC
• Sara Titus, CRNA
• Linda Sharon Tobinhunter, PTA
• Christine B Tocchi, APRN
• Vicky B Tola, MD
• Ian Campbell Tolmie, DO
• Jacob Austin James Tompkins, M.D.
• Mariia Tonkoshkur, M.D.
• Jean M Tornatore, M.D.
• Alyssa Torres, M.S. CCC-SLP

• Clinical Social Worker in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.