Active NPI
Krysellys A Acosta, MSW, LCSW
- Clinical Social Worker
- Plainfield, IL
National Provider Identifier
1992214563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 225832
- Practice address
- 10204 Bode St Ste B
Plainfield, IL 60585-9813 - Phone
- (774) 334-4808
- NPI assigned
- Sep 26, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 122229101 | MA | |
| Clinical Social Worker | 1041C0700X | 225832 | MA | Primary |
Addresses
Primary practice location
10204 Bode St Ste B
Plainfield, IL 60585-9813
Mailing address
PO Box 21
Webster, MA 01570-0021
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 |
|---|---|---|---|
| 122229101 | MA | MD | Social Worker |
| 225832 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637280000000",
"number": "1992214563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 21",
"city": "WEBSTER",
"state": "MA",
"postal_code": "015700021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10204 BODE ST STE B",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605859813",
"telephone_number": "774-334-4808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACOSTA",
"first_name": "KRYSELLYS",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-26",
"last_updated": "2021-11-19",
"certification_date": "2021-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "122229101",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "225832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plainfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.