Keryn Johnson Benasuly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW006320 Issued in GA

Practice address

2000 Riverside Pkwy Ste 107
Lawrenceville, GA 30043-5926

Phone

(678) 878-3215

Fax

(678) 878-3341

NPI assigned

Mar 4, 2018

Last updated

Mar 4, 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

Medicare fee-for-service enrollment

Enrolled in GA

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

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.

• Clover Center Counseling, LLC

  • Mental Health Counselor
  • Scottdale, GA
  • NPI 1831059385
  Medicare reassignment NPD Authorized official
• SB Healthcare, LLC

  dba BridgeWay Hospice

  • Community Based Hospice Care Agency
  • Lawrenceville, GA
  • NPI 1003273095
  NPD (past)
• SB Healthcare, LLC

  dba BridgeWay Palliative Care

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Lawrenceville, GA
  • NPI 1235669045
  NPD (past)

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

{
    "created_epoch": "1520121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520121600000",
    "number": "1649772872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BRIDGEWAY HOSPICE",
            "address_2": "2000 RIVERSIDE PKWY SUITE 107",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30043",
            "telephone_number": "678-878-3215",
            "fax_number": "678-878-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 RIVERSIDE PKWY STE 107",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435926",
            "telephone_number": "678-878-3215",
            "fax_number": "678-878-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENASULY",
        "first_name": "KERYN",
        "middle_name": "JOHNSON",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-04",
        "last_updated": "2018-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW006320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tawanna Bell
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• Amber Belle, LMSW
• Breeanna Bellinger, LMSW
• Beverly Emelina Beltran, FNP
• Yadiry K Benavides
• Benchmark Physical Therapy, Inc
• Kimberly Benefield
• Richard Wayne Benefield, PA-C
• Mary T Benjamin, DDS

• Clinical Social Worker in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.