Individual provider Active NPI

Coree L Kirsch, LICSW

  • Clinical Social Worker
  • Burlington, VT
National Provider Identifier
1548347313
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
089-0000929 Issued in VT
Practice address
1138 Pine St
Burlington, VT 05401-5353
Phone
(802) 488-6600
Fax
(802) 488-6919
NPI assigned
Nov 1, 2006
Last updated
Feb 8, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 089-0000929 VT Primary

Addresses

Primary practice location

1138 Pine St
Burlington, VT 05401-5353

Mailing address

208 Flynn Ave
3J
Burlington, VT 05401-5429
Phone (802) 488-6600

Other identifiers 1

IdentifierTypeStateIssuer
1009347MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20071010000614 VT Practitioner - Clinical Social Worker 1456447143 Practice locations: Essex JCT, VT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11 Pearl St
Suite 102
Essex JCT, VT 05452-3650
Phone (802) 277-0195

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
089-0000929VTMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1548347313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 FLYNN AVE",
            "address_2": "3J",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015429",
            "telephone_number": "802-488-6600",
            "fax_number": "802-488-6919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 PINE ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015353",
            "telephone_number": "802-488-6600",
            "fax_number": "802-488-6919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRSCH",
        "first_name": "COREE",
        "middle_name": "L",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089-0000929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009347",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.