NPIMap

Organization Active NPI

Kelly Collaborative Care, Inc

  • Professional Counselor
  • Dennis, MA
National Provider Identifier
1124349998
Registry record updated Dec 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
197116 Issued in MA
Legal business name
KELLY COLLABORATIVE CARE, INC
Practice address
616 Route 6a
Dennis, MA 02638-1906
Phone
(773) 487-7647
NPI assigned
Jun 16, 2010
Last updated
Dec 13, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2010

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

Authorized official

Name
Mary Hettich-Kelly, FNP-BC, RNCSNPI 1790810257
Title
Owner
Phone
(774) 487-7647

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 197116 MA Primary

Addresses

Primary practice location

616 Route 6a
Dennis, MA 02638-1906

Mailing address

180 Old Red Top Rd
Brewster, MA 02631-2370
Phone (774) 487-7647

National Provider Directory

National Provider Directory

Locations

616 Route 6A
Dennis, MA 02638
Phone (508) 385-2550

38 Route 134
#7
South Dennis, MA 02660
Phone (774) 487-7647

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292198400000",
    "number": "1124349998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 OLD RED TOP RD",
            "city": "BREWSTER",
            "state": "MA",
            "postal_code": "026312370",
            "telephone_number": "774-487-7647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 ROUTE 6A",
            "city": "DENNIS",
            "state": "MA",
            "postal_code": "026381906",
            "telephone_number": "773-487-7647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY COLLABORATIVE CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2010-12-13",
        "status": "A",
        "authorized_official_last_name": "HETTICH-KELLY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "774-487-7647",
        "authorized_official_credential": "FNP-BC, RNCS"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MA",
            "license": "197116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dennis, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2010; 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.