Active NPI
Kelly Elizabeth Sullivan
- School Social Worker
- Escondido, CA
National Provider Identifier
1003609967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- 230128265
- Practice address
- 2869 N Broadway
Escondido, CA 92026-8802 - Phone
- (760) 739-5800
- NPI assigned
- May 23, 2025
- 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 |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | 230128265 | CA | Primary |
Addresses
Primary practice location
2869 N Broadway
Escondido, CA 92026-8802
Mailing address
2869 N Broadway
Escondido, CA 92026-8802
Phone (760) 739-5800
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 230128265 | CA | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747958400000",
"number": "1003609967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2869 N BROADWAY",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920268802",
"telephone_number": "760-739-5800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2869 N BROADWAY",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920268802",
"telephone_number": "760-739-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KELLY",
"middle_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-23",
"last_updated": "2025-05-23",
"certification_date": "2025-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "CA",
"license": "230128265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escondido, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.