Kelley Anne Smith, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

121289 Issued in MA

Practice address

290 Turnpike Rd Ste 5-138
Westborough, MA 01581-2843

Phone

(508) 418-6608

Fax

(508) 475-9396

NPI assigned

Sep 17, 2010

Last updated

Jul 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kelley Anne Whittaker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 3, 2023 through Feb 3, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Collective Counseling Center, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Westborough, MA
  • NPI 1366923005
  NPD Authorized official

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

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1093023517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 TURNPIKE RD STE 5-138",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "015812843",
            "telephone_number": "508-418-6608",
            "fax_number": "508-475-9396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 TURNPIKE RD STE 5-138",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "015812843",
            "telephone_number": "508-418-6608",
            "fax_number": "508-475-9396"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Columbus Ave",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065191233",
            "country_code": "US",
            "telephone_number": "203-503-3075",
            "fax_number": "203-503-3296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLEY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-17",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "121289",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "8448",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "WHITTAKER",
            "middle_name": "ANNE",
            "credential": "BA, CPRP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jerome David Siegel, MD
• Carlos Silva, LICSW
• Deborah Alexa Sirko-Osadsa, PH.D., FACMG
• Sleep Apnea Solutions LLC
• Smile Land Dental Care, LLC
• Niamh Ione Smithers, LMHC
• Sarah C. Soares, MS
• David Sommer, MD
• Somnovision
• Heather Anne Sousa

• Clinical Social Worker in Westborough, MA
• Providers in Westborough, 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 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.