Active NPI
Jessica Kundrata, LCSW
- Clinical Social Worker
- Augusta, ME
National Provider Identifier
1699224600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC17320
- Practice address
- 1 Alden Ave
Augusta, ME 04330-6185 - Phone
- (207) 626-3497
- Fax
- (207) 621-6211
- NPI assigned
- Oct 3, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC17320 | ME | Primary |
Addresses
Primary practice location
1 Alden Ave
Augusta, ME 04330-6185
Mailing address
1 Alden Ave
Augusta, ME 04330-6185
Phone (207) 626-3497
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
| License | State | Type | Specialty |
|---|---|---|---|
| LC17320 | ME | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Center: Early Intervention and Family Support, Inc. | Past | Accepting new patients |
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.
-
- Specialist
- Augusta, ME
- NPI 1174763411
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549152000000",
"number": "1699224600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 ALDEN AVE",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043306185",
"telephone_number": "207-626-3497",
"fax_number": "207-621-6211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 ALDEN AVE",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043306185",
"telephone_number": "207-626-3497",
"fax_number": "207-621-6211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUNDRATA",
"first_name": "JESSICA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-03",
"last_updated": "2019-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "LC17320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.