Kristen Eberly

Primary specialty

Social WorkerTaxonomy code 104100000X

License

108259 Issued in NY

Practice address

211 J.B. Wise Plaza
Watertown, NY 13601

Phone

(315) 782-7445

Fax

(315) 779-1184

NPI assigned

Jan 27, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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 and National Provider Directory roles.

• Children'S Home of Jefferson County

  • Community/Behavioral Health Agency
  • Watertown, NY
  • NPI 1538455696
  NPD
• Children'S Home of Jefferson County

  • Case Management Agency
  • Watertown, NY
  • NPI 1770625527
  NPD

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1831720143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6550",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136016550",
            "telephone_number": "315-788-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 J.B. WISE PLAZA",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "13601",
            "telephone_number": "315-782-7445",
            "fax_number": "315-779-1184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "167 Polk St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "NY",
            "postal_code": "136012770",
            "country_code": "US",
            "telephone_number": "315-782-7445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBERLY",
        "first_name": "KRISTEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-27",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "108259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Dwello, PA
• Early Pathways, Inc.
• Early Pathways, Inc.
• East Coast Audiology and Physical Therapy, PLLC
• Joan Ellen Ebblie, LAC, RN
• Barbara Anne Edgar, OTR/L
• Edmund J Roache MD
• Edmund Joseph Roache, M.D.
• Ehsoc
• Erica Eichner, LMSW

• All providers in Watertown, NY
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.