Individual provider Active NPI

Kristen Rea, LCSW

  • Clinical Social Worker
  • Syracuse, NY
National Provider Identifier
1730263674
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R044955-1 Issued in NY
Practice address
600 E Genesee St
217
Syracuse, NY 13202-3130
Phone
(315) 422-0300
Fax
(315) 479-8455
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 R044955-1 NY Primary

Addresses

Primary practice location

600 E Genesee St
217
Syracuse, NY 13202-3130

Mailing address

600 E Genesee St
217
Syracuse, NY 13202-3130
Phone (315) 422-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20040817000636 NY Practitioner - Clinical Social Worker 2769455849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blair Counseling ServicesGroup PAC ID 5799158051, 5 clinicians

Practice addresses (Care Compare)

2112 Erie Blvd E
Suite 200
Syracuse, NY 13224-1041

6493 Ridings Rd
Suite 115
Syracuse, NY 13206-1120
Phone (315) 813-7062

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R044955-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psychological Healthcare, PLLC CurrentSince Jun 1, 2012 Accepting new patients
Blair Counseling Services Clinical CurrentSince Jul 4, 2024 Accepting new patients

Locations

8289 Loop Rd
Baldwinsville, NY 13027
Phone (315) 452-0300

600 E Genesee St
Ste 217
Syracuse, NY 13202
Phone (315) 452-0300

2112 Erie Blvd E
Ste 200
Syracuse, NY 13224
Phone (315) 472-1212

3300 James St
Ste 100
Syracuse, NY 13206

6493 Ridings Rd
Ste 115
Syracuse, NY 13206
Phone (315) 813-7062

Organizations & group practices 2

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730263674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E GENESEE ST",
            "address_2": "217",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023130",
            "telephone_number": "315-422-0300",
            "fax_number": "315-479-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E GENESEE ST",
            "address_2": "217",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023130",
            "telephone_number": "315-422-0300",
            "fax_number": "315-479-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REA",
        "first_name": "KRISTEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R044955-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.