Manny Brice Kelly, LPT

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

33817 Issued in CA

Practice address

1481 Windsor Dr
San Bernardino, CA 92404-5416

Phone

(909) 361-6472

Fax

(909) 203-7403

NPI assigned

Apr 22, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Telecare Corporation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Bernardino, CA
  • NPI 1912418930
  NPD (past)

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555891200000",
    "number": "1003479320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2895 W FAIRVIEW DR",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923773425",
            "telephone_number": "909-435-5341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1481 WINDSOR DR",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045416",
            "telephone_number": "909-361-6472",
            "fax_number": "909-203-7403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MANNY",
        "middle_name": "BRICE",
        "credential": "LPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-22",
        "last_updated": "2019-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "33817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronica Lynn Kelley, LCSW
• Padmini Kelly-Skinner, RN
• Brittany Kelly, LVN
• Elizabeth Ann Kelly, MFTI
• Jessica Kelly
• Mopelola Beatrice Keme
• Yetunde Keme
• Sierra Kemock
• Teresa Kendall
• Kenka Pathways LLC

• Licensed Psychiatric Technician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.