Susan Kelly, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111523 Issued in MA

Practice address

42 Wendell Avenue
Pittsfield, MA 01201

Phone

(413) 281-8984

Fax

(413) 496-9116

NPI assigned

Nov 28, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Milton Silverstein, PH.D., P.C.

  • Counseling Psychologist
  • Pittsfield, MA
  • NPI 1558786780
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1043386246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 PECKS RD",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012011339",
            "telephone_number": "413-281-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 WENDELL AVENUE",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "01201",
            "telephone_number": "413-281-8984",
            "fax_number": "413-496-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SUSAN",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1855417",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "P08627",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Keller, LICSW
• Brian Edward Kelley, LICSW
• Nicholas Kelley
• Karen G Kelly, MD
• Sarah Kelly
• Jessica Kemp, RN
• Kelly Kennedy, MS, RD, LDN
• Mark Glenn Kenyon, LMFT
• Erin K Kern-Egan, LICSW
• Carrie Kersavage

• Clinical Social Worker in Pittsfield, MA
• Providers in Pittsfield, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.