Kristina Lynn Carrera, MSW, LCSW, LAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW.09923606 Issued in CO

Practice address

2429 S Prairie Ave
Pueblo, CO 81005-2886

Phone

(719) 564-5070

Fax

(719) 896-2874

NPI assigned

Mar 8, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kristine Lynn Scull Former name

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

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Gateway to Success, PCGroup PAC ID 3173885670, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Gateway to Success, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pueblo, CO
  • NPI 1922348481
  Medicare reassignment Care Compare group NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  CO

  Medicare reassignment NPD
• Gateway to Success, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Colorado Springs, CO
  • NPI 1275172967
  NPD
• Gateway to Success, PC

  • Medical Specialty Clinic/Center
  • Pueblo, CO
  • NPI 1770958423
  NPD
• Gateway to Success, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Canon City, CO
  • NPI 1093354680
  NPD (past)
• Gateway to Success, PC

  • Medical Specialty Clinic/Center
  • Colorado Springs, CO
  • NPI 1396384087
  NPD (past)
• Gateway to Success, PC

  • Medical Specialty Clinic/Center
  • Canon City, CO
  • NPI 1629422290
  NPD (past)

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

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569542400000",
    "number": "1992079925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RUSKIN DRIVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80910",
            "telephone_number": "719-572-6100",
            "fax_number": "719-447-4792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2429 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052886",
            "telephone_number": "719-564-5070",
            "fax_number": "719-896-2874"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "602 Yale Pl",
            "address_purpose": "LOCATION",
            "city": "Canon City",
            "state": "CO",
            "postal_code": "812124611",
            "country_code": "US",
            "telephone_number": "719-275-0700",
            "fax_number": "719-275-0700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "155 Printers Pkwy",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809106100",
            "country_code": "US",
            "telephone_number": "719-374-1650",
            "fax_number": "719-896-2874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARRERA",
        "first_name": "KRISTINA",
        "middle_name": "LYNN",
        "credential": "MSW, LCSW, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-08",
        "last_updated": "2019-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "1057",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09923606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINE",
            "last_name": "SCULL",
            "middle_name": "LYNN",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carmel Community Living Corporation
• Rae Carnevale
• Hannah Carney
• Brandy Caro
• Nathan Isaac Carpenter, PA
• John Carrero
• Gabrielle Carrillo
• Jodeen Carrillo, RN
• Amalie Miller Carrino, PA-C
• Julie-Anne Josephine Carroll

• Clinical Social Worker in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.