Katie Kelly

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

31355 Issued in NY

Practice address

2435 6TH Ave
Troy, NY 12180-2227

Phone

(518) 274-5143

NPI assigned

Feb 29, 2016

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Liverpool, NY
  • NPI 1366498768
  NPD (past)
• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Glens Falls, NY
  • NPI 1972558179
  NPD (past)

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1194185553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 PEARL ST",
            "city": "SCHUYLERVILLE",
            "state": "NY",
            "postal_code": "128711114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 6TH AVE",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121802227",
            "telephone_number": "518-274-5143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Elm St",
            "address_purpose": "LOCATION",
            "city": "Glens Falls",
            "state": "NY",
            "postal_code": "128013549",
            "country_code": "US",
            "telephone_number": "518-793-7273",
            "fax_number": "518-798-5004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KATIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-29",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "31355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen Elizabeth Kelley, MD
• Mikaela Marie Kellogg, PMHNP
• Anne M. Kelly, MS, CCC-SLP
• Eric Michael Kelly, DPT, MS, CSCS
• Joseph M. Kelly, LCSW
• Lauren Kelly, CASAC-T
• Maria Theresa Kelly, MS, RDN, CDN
• Glenda B Kelman, PHD, APRN, BC
• Rhiannon Mary Kelsh-Lasher, MD, PHD
• Kayla Kendall

• All providers in Troy, NY
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.