Individual provider Active NPI

Kristen Eileen Wiltshire, LCSW

  • Clinical Social Worker
  • Southbury, CT
National Provider Identifier
1982858155
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
071095 Issued in NY
Practice address
544 Judd Rd
Southbury, CT 06488-1938
Phone
(203) 314-0991
NPI assigned
Nov 13, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 13375 CT
Clinical Social Worker 1041C0700X 071095 NY Primary

Addresses

Primary practice location

544 Judd Rd
Southbury, CT 06488-1938

Mailing address

544 Judd Rd
Southbury, CT 06488-1938
Phone (203) 314-0991

Other practice location 1

2320 Losee Ct
North Merrick, NY 11566-2267
Phone (516) 761-0795

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20231204000438 CT Practitioner - Clinical Social Worker 6406204379 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071095NYMDAmbulatory Care Pharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Compassionate Care Counseling LLC CurrentSince Oct 8, 2023 Accepting new patients
Behavioral Health Center for Counseling & Learning, LLC CurrentSince Oct 8, 2023 Accepting new patients
CT Healing Center Past Accepting new patients

Locations

984 Southford Rd
Middlebury, CT 06762
Phone (203) 758-2400

1000 Bridgeport Ave
Ste 202
Shelton, CT 06484
Phone (203) 712-9998

Organizations & group practices 3

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": "1226534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1982858155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "544 JUDD RD",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064881938",
            "telephone_number": "203-314-0991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "544 JUDD RD",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064881938",
            "telephone_number": "203-314-0991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2320 Losee Ct",
            "address_purpose": "LOCATION",
            "city": "North Merrick",
            "state": "NY",
            "postal_code": "115662267",
            "country_code": "US",
            "telephone_number": "516-761-0795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILTSHIRE",
        "first_name": "KRISTEN",
        "middle_name": "EILEEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-13",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "13375",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "071095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbury, CT

Sources for this page

Verify at the official NPI Registry.