Kellie Madison Vaughn, LSW, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SL07280400 Issued in NJ

Practice address

595 Chestnut Ridge Rd Ste 4
Woodcliff Lake, NJ 07677-7667

Phone

(551) 368-0307

NPI assigned

May 9, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755648000000",
    "number": "1104674779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 CHESTNUT RIDGE RD STE 4",
            "city": "WOODCLIFF LAKE",
            "state": "NJ",
            "postal_code": "076777667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 CHESTNUT RIDGE RD STE 4",
            "city": "WOODCLIFF LAKE",
            "state": "NJ",
            "postal_code": "076777667",
            "telephone_number": "551-368-0307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "KELLIE",
        "middle_name": "MADISON",
        "credential": "LSW, LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-09",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL07280400",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "128018",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SL07280400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Woodcliff Lake, NJ
• Providers in Woodcliff Lake, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.

Verify at the official NPI Registry.