Kelley R Hendricken, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111101 Issued in MA

Practice address

6 Juneberry LN
Worcester, MA 01606-1194

Phone

(774) 239-4161

NPI assigned

Sep 26, 2006

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Third Space Therapy PLLC

  • Mental Health Counselor
  • Houston, TX
  • NPI 1215780234

  MA

  Medicare reassignment NPD
• New York State Health Medical PC

  • Mental Health Counselor
  • New York, NY
  • NPI 1043156029
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1184725855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 JUNEBERRY LN",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061194",
            "telephone_number": "774-239-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 JUNEBERRY LN",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061194",
            "telephone_number": "774-239-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKEN",
        "first_name": "KELLEY",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Nicole Henderson, M.A.
• James Henderson
• William Monroe Henderson, M.D.
• Zachary Henderson, FNP
• Catherine Melchior Hendren
• Imani A Hendricks
• Jennifer Hendrickson, INTERN
• Elizabeth A. Hendriks, PHD
• Ryan J. Hendrix, MD
• Jenepher Ann Henkins, LICSW

• Clinical Social Worker in Worcester, MA
• Providers in Worcester, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.