Individual provider Active NPI

Kristine Marie Roberts, LCSW

  • Clinical Social Worker
  • Bastrop, TX
National Provider Identifier
1881875615
Registry record updated Mar 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
67295 Issued in TX
Practice address
1106 College St Ste E
Bastrop, TX 78602-4021
Phone
(512) 521-3243
NPI assigned
Nov 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-16769 AZ
Clinical Social Worker 1041C0700X 149009815 IL
Clinical Social Worker 1041C0700X 67295 TX Primary

Addresses

Primary practice location

1106 College St Ste E
Bastrop, TX 78602-4021

Mailing address

326 Belinda CT
Bastrop, TX 78602-6617
Phone (757) 879-2269

Other names 1

  • Kris Marie Cisco Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20190718000371 TX Practitioner - Clinical Social Worker 7810079670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

1106 College St
Bastrop, TX 78602-4021
Phone (855) 284-7483

4903 82ND St
Suite 60
Lubbock, TX 79424-3123
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
67295TXMDProfessional Counselor
149009815ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Aug 26, 2021 Accepting new patients

Locations

1000 Post and Paddock St
Ste 102
Grand Prairie, TX 75050

4903 82nd St
Ste 60
Lubbock, TX 79424
Phone (806) 507-6934

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553558400000",
    "number": "1881875615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 BELINDA CT",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786026617",
            "telephone_number": "757-879-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 COLLEGE ST STE E",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786024021",
            "telephone_number": "512-521-3243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KRISTINE",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-20",
        "last_updated": "2019-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-16769",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149009815",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "67295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRIS",
            "last_name": "CISCO",
            "middle_name": "MARIE",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bastrop, TX

Sources for this page

Verify at the official NPI Registry.