Active NPI
Enna Edwardovna Khondkaryan, LCSW
- Clinical Social Worker
- New Haven, CT
National Provider Identifier
1962900381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 010075
- Practice address
- 40 Temple St Ste 7C
New Haven, CT 06510-2715 - Phone
- (203) 737-5876
- Fax
- (203) 737-5455
- NPI assigned
- Jan 31, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 010075 | CT | Primary |
Addresses
Primary practice location
40 Temple St Ste 7C
New Haven, CT 06510-2715
Mailing address
14 Crofut Rd
Orange, CT 06477-2508
Phone (203) 676-6494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010075 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519084800000",
"number": "1962900381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 CROFUT RD",
"city": "ORANGE",
"state": "CT",
"postal_code": "064772508",
"telephone_number": "203-676-6494",
"fax_number": "203-737-5455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 TEMPLE ST STE 7C",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065102715",
"telephone_number": "203-737-5876",
"fax_number": "203-737-5455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHONDKARYAN",
"first_name": "ENNA",
"middle_name": "EDWARDOVNA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-31",
"last_updated": "2018-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "010075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.