Individual provider Active NPI

Katrina Puente

  • Social Worker
  • Boulder, CO
National Provider Identifier
1871923417
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
1333 Iris Ave
Boulder, CO 80304-2226
Phone
(303) 443-8500
NPI assigned
Nov 18, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Social Worker 104100000X NU Primary

Addresses

Primary practice location

1333 Iris Ave
Boulder, CO 80304-2226

Mailing address

1333 Iris Ave
Boulder, CO 80304-2226
Phone (303) 443-8500

Other practice location 1

2275 Arlington Dr
San Leandro, CA 94578-1132
Phone (510) 317-1444

Other identifiers 1

IdentifierTypeStateIssuer
1093767543MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20210630003450 CO Practitioner - Clinical Social Worker 9335540129 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Umbrella Collective Inc Clinical CurrentSince May 1, 2021 Accepting new patients

Locations

2769 Iris Ave
Ste 118
Boulder, CO 80304
Phone (720) 663-0163

2919 Valmont Rd
Ste 104
Boulder, CO 80301
Phone (303) 442-2126

3464 S Willow St
Ste 185
Denver, CO 80231

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1871923417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226",
            "telephone_number": "303-443-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226",
            "telephone_number": "303-443-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2275 Arlington Dr",
            "address_purpose": "LOCATION",
            "city": "San Leandro",
            "state": "CA",
            "postal_code": "945781132",
            "country_code": "US",
            "telephone_number": "510-317-1444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUENTE",
        "first_name": "KATRINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093767543",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.