NPIMap

Individual provider Active NPI

Kelly Marie Reardon, MLADC

  • Addiction (Substance Use Disorder) Counselor
  • Manchester, NH
National Provider Identifier
1174887145
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
0684 Issued in NH
Practice address
101 Manchester St
Manchester, NH 03101-2205
Phone
(603) 625-6980
Fax
(603) 625-6982
NPI assigned
Jun 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 0684 NH Primary

Addresses

Primary practice location

101 Manchester St
Manchester, NH 03101-2205

Mailing address

101 Manchester St
Manchester, NH 03101-2205
Phone (603) 625-6980

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

State licenses

LicenseStateTypeSpecialty
0684NHMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Sernity Place Past Accepting new patients
Serenity Place Past Accepting new patients

Organizations & group practices 2

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": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340582400000",
    "number": "1174887145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MANCHESTER ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031012205",
            "telephone_number": "603-625-6980",
            "fax_number": "603-625-6982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MANCHESTER ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031012205",
            "telephone_number": "603-625-6980",
            "fax_number": "603-625-6982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REARDON",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "MLADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NH",
            "license": "0684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; 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.