Active NPI
David E Kelly, LCSW
- Clinical Social Worker
- Norwalk, CT
National Provider Identifier
1184950032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 006989
- Practice address
- 10 Mott Ave
Suite 2E
Norwalk, CT 06850-3320 - Phone
- (203) 505-8782
- NPI assigned
- Oct 28, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 006989 | CT | Primary |
Addresses
Primary practice location
10 Mott Ave
Suite 2E
Norwalk, CT 06850-3320
Mailing address
10 Mott Ave
Suite 2E
Norwalk, CT 06850-3320
Phone (203) 505-8782
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 1, 2024 through Mar 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006989 | CT | MD | Speech-Language Pathologist |
| 6989 | CT | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266969600000",
"number": "1184950032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 MOTT AVE",
"address_2": "SUITE 2E",
"city": "NORWALK",
"state": "CT",
"postal_code": "068503320",
"telephone_number": "203-505-8782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 MOTT AVE",
"address_2": "SUITE 2E",
"city": "NORWALK",
"state": "CT",
"postal_code": "068503320",
"telephone_number": "203-505-8782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "DAVID",
"middle_name": "E",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-28",
"last_updated": "2010-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "006989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwalk, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.