Individual provider Active NPI

Theresa Burak

  • Clinical Social Worker
  • Middletown, CT
National Provider Identifier
1639966229
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
15087 Issued in CT
Practice address
1250 Silver St
Middletown, CT 06457-3946
Phone
(860) 852-1019
NPI assigned
Apr 24, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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 15087 CT Primary

Addresses

Primary practice location

1250 Silver St
Middletown, CT 06457-3946

Mailing address

1250 Silver St
Middletown, CT 06457-3946

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250502000767 CT Practitioner - Clinical Social Worker 9830615889 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rushford Center, Inc. Clinical CurrentSince Apr 1, 2025 Accepting new patients

Locations

883 Paddock Ave
Meriden, CT 06450
Phone (203) 630-5220

1250 Silver St
Middletown, CT 06457
Phone (860) 346-0300

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1745452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1639966229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 SILVER ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 SILVER ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573946",
            "telephone_number": "860-852-1019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURAK",
        "first_name": "THERESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-24",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "15087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

Verify at the official NPI Registry.