Kerry Lynn Ketchale, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

005794 Issued in CT

Practice address

420 Somers Rd
Ellington, CT 06029-2629

Phone

(860) 255-4475

NPI assigned

Jul 20, 2010

Last updated

Jun 22, 2024By 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 names 1

• Mrs. Kerry Lynn Tuttle Former name

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Just Breathe Connecticut LLC

  • Clinical Social Worker
  • Ellington, CT
  • NPI 1821420977
  Medicare reassignment NPD

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

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719014400000",
    "number": "1518270446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SOMERS RD",
            "city": "ELLINGTON",
            "state": "CT",
            "postal_code": "060292629",
            "telephone_number": "860-255-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 SOMERS RD",
            "city": "ELLINGTON",
            "state": "CT",
            "postal_code": "060292629",
            "telephone_number": "860-255-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHALE",
        "first_name": "KERRY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-20",
        "last_updated": "2024-06-22",
        "certification_date": "2024-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "005794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "TUTTLE",
            "middle_name": "LYNN",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Just Breathe Connecticut LLC
• Kaitlin Myska LMFT LLC
• Karen Case LPC LLC
• Kelly a. Schmidt, PH.D., LLC
• Craig Thomas Kelly, L.AC.
• Mary Kay Kittredge, LCSW
• Iwona Krakowiak
• Rebecca Beth Krusinski, LCSW
• Nicole Michele Labonte, OTR/L
• Steven Jay Landman, D.D.S.

• Clinical Social Worker in Ellington, CT
• Providers in Ellington, 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 Jun 22, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.