Active NPI
Kelly A Maddalena, LCSW, LMHP, LIMHP
- Clinical Social Worker
- Omaha, NE
National Provider Identifier
1093709164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1006
- Practice address
- 15106 Spencer St
Omaha, NE 68116-8106 - Phone
- (402) 594-4911
- NPI assigned
- Sep 6, 2005
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 509 | NE | |
| Social Worker | 104100000X | 1006 | NE | |
| Clinical Social Worker | 1041C0700X | 1006 | NE | Primary |
Addresses
Primary practice location
15106 Spencer St
Omaha, NE 68116-8106
Mailing address
15106 Spencer St
Omaha, NE 68116-8106
Phone (402) 594-4911
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85120 | Other | BCBS |
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
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1006 | DE | MD | Prosthodontist |
| 509 | NE | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychiatric Services, PC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730419200000",
"number": "1093709164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15106 SPENCER ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681168106",
"telephone_number": "402-594-4911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15106 SPENCER ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681168106",
"telephone_number": "402-594-4911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDALENA",
"first_name": "KELLY",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LCSW, LMHP, LIMHP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-09-06",
"last_updated": "2024-11-01",
"certification_date": "2024-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "509",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker",
"state": "NE",
"license": "1006",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "NE",
"license": "1006",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "85120",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.