Individual provider Active NPI

Audrie L Karraker, LCSW

  • Clinical Social Worker
  • Bridgeport, CT
National Provider Identifier
1730290743
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
006191 Issued in CT
Practice address
790 Central Ave
Bridgeport, CT 06607-1705
Phone
(203) 332-4567
Fax
(203) 332-4568
NPI assigned
Aug 31, 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 006191 CT Primary

Addresses

Primary practice location

790 Central Ave
Bridgeport, CT 06607-1705

Mailing address

471 Barnum Ave
Bridgeport, CT 06608-2409
Phone (203) 333-6864

Other identifiers 1

IdentifierTypeStateIssuer
006191OtherCTLICENSE

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
I20160112002352 CT Practitioner - Clinical Social Worker 3971805631 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Practice addresses (Care Compare)

64 Robbins St
Waterbury, CT 06708-2613
Phone (203) 573-6263

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006191CTMDGeneral Practice Dentistry
6191CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Griffin Hospital CurrentSince Nov 4, 2015 Accepting new patients
State of Connecticut CurrentSince Apr 8, 2022 Accepting new patients
Prospect CT Medical Foundation, Inc. Clinical CurrentSince Jul 25, 2018 Accepting new patients
State of Connecticut CurrentSince Apr 8, 2022 Accepting new patients

Locations

1801 W Olympic Blvd
#2201
Pasadena, CA 91199

130 Division St
Derby, CT 06418
Phone (203) 732-1330

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

18 Haynes St
Uppr
Manchester, CT 06040
Phone (860) 649-7557

55 W Main St
Ste 410
Waterbury, CT 06702
Phone (203) 805-6408

95 Thomaston Ave
Waterbury, CT 06702
Phone (203) 805-5300

64 Robbins St
Waterbury, CT 06708
Phone (203) 573-7142

Organizations & group practices 4

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730290743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 BARNUM AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066082409",
            "telephone_number": "203-333-6864",
            "fax_number": "203-332-0376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CENTRAL AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066071705",
            "telephone_number": "203-332-4567",
            "fax_number": "203-332-4568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARRAKER",
        "first_name": "AUDRIE",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "006191",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.