Active NPI
Amber M Kelly, LMSW
- Social Worker
- Bath, NY
National Provider Identifier
1043783251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 103521
- Practice address
- 76 Veterans Ave # 11630210
Bath, NY 14810-0840 - Phone
- (607) 664-4000
- Fax
- (607) 664-4360
- NPI assigned
- Jan 10, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 103521 | NY | Primary |
Addresses
Primary practice location
76 Veterans Ave # 11630210
Bath, NY 14810-0840
Mailing address
73 Veterans Ave
BH-116-30-210
Bath, NY 14810
Phone (607) 664-4000
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 |
|---|---|---|---|
| 103521 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547078400000",
"number": "1043783251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "73 VETERANS AVE",
"address_2": "BH-116-30-210",
"city": "BATH",
"state": "NY",
"postal_code": "14810",
"telephone_number": "607-664-4000",
"fax_number": "607-664-4360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 VETERANS AVE # 11630210",
"city": "BATH",
"state": "NY",
"postal_code": "148100840",
"telephone_number": "607-664-4000",
"fax_number": "607-664-4360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "AMBER",
"middle_name": "M",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-10",
"last_updated": "2019-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "103521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bath, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.