Individual provider Active NPI

Rebecca Michele Kaletsky Goldberg, LCSW

  • Clinical Social Worker
  • New Haven, CT
National Provider Identifier
1548694680
Registry record updated Aug 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
003440 Issued in CT
Practice address
646 George St
New Haven, CT 06511-5322
Phone
(203) 789-4038
Fax
(203) 867-5279
NPI assigned
Aug 26, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2013

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 003440 CT Primary

Addresses

Primary practice location

646 George St
New Haven, CT 06511-5322

Mailing address

646 George St
New Haven, CT 06511-5322
Phone (203) 789-4038

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

LicenseStateTypeSpecialty
003440CTMDAdult Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1377475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377475200000",
    "number": "1548694680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "646 GEORGE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115322",
            "telephone_number": "203-789-4038",
            "fax_number": "203-867-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "646 GEORGE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115322",
            "telephone_number": "203-789-4038",
            "fax_number": "203-867-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALETSKY GOLDBERG",
        "first_name": "REBECCA",
        "middle_name": "MICHELE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-26",
        "last_updated": "2013-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "003440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.