Korey J. Puckett, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC50079247 Issued in DC

Practice address

1629 K St NW
Suite 300
Washington, DC 20006-1602

Phone

(410) 236-0028

NPI assigned

Jan 3, 2012

Last updated

Jan 3, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 DC

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

State licenses

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325548800000",
    "number": "1750651139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5815 COMSTOCK AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212062214",
            "telephone_number": "410-236-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1629 K ST NW",
            "address_2": "SUITE 300",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200061602",
            "telephone_number": "410-236-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "KOREY",
        "middle_name": "J.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-03",
        "last_updated": "2012-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50079247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devon Pu, LGSW
• Jingxiong Pu, MD
• Public Charter School Center for Student Support Services
• Sindhuja Reddy Puchakayala
• Christina M. Puchalski, MD
• Caileigh Pudela, MD
• Jessica Ann Pudlo, NP
• Antonio Nicolas Puente, PH.D
• Mario Puerta
• Martha Pufong

• Clinical Social Worker in Washington, DC
• Providers in Washington, DC by specialty
• Clinical Social Worker in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; 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.