Shelly Kelley

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

31 Lake St
Gardner, MA 01440-3879

Phone

(978) 632-9400

Fax

(978) 632-6425

NPI assigned

May 22, 2014

Last updated

May 22, 2014By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• North Central Human Serv Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Gardner, MA
  • NPI 1982736633
  NPD (past)

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400716800000",
    "number": "1144632340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 449",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014400449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 LAKE ST",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014403879",
            "telephone_number": "978-632-9400",
            "fax_number": "978-632-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "SHELLY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-22",
        "last_updated": "2014-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Ann Kacian, MA, CAGS
• Mary Ann Cynthia Kairouz
• Kalyan Kalava, M.D.
• Richard E Keelan, MA
• Hannah Keesee
• Vernon Kellog, MD
• Nicholas J Killick, LMHC
• Beyang Kima-Tabong, RPH
• Matthew Sposito Kincaid
• Antonina Salvatrice Klauzinski, FNP

• Mental Health Counselor in Gardner, MA
• Providers in Gardner, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.