Shannon Marie Kelly, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LCSW75222 Issued in CA

Practice address

200 S Wells Rd Ste 250
Ventura, CA 93004-1383

Phone

(805) 647-0991

Fax

(805) 647-7163

NPI assigned

Sep 25, 2012

Last updated

Mar 7, 2019By 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 CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sud Specialty Group - Ca

  dba Rula Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238
  Medicare reassignment NPD
• Clinicas del Camino Real Inc

  dba Clinicas del Camino Real, Inc., Paseo Camarillo

  • Federally Qualified Health Center (FQHC)
  • Camarillo, CA
  • NPI 1295297190
  NPD (past)
• Clinicas del Camino Real Inc

  dba Clinicas del Camino Real, Inc., La Colonia

  • Federally Qualified Health Center (FQHC)
  • Oxnard, CA
  • NPI 1942789359
  NPD (past)

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

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551916800000",
    "number": "1205187788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125092",
            "telephone_number": "805-673-3930",
            "fax_number": "805-659-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S WELLS RD STE 250",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041383",
            "telephone_number": "805-647-0991",
            "fax_number": "805-647-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-25",
        "last_updated": "2019-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "LCSW75222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Marie Kellner
• Dylan L Kelly, DPT
• Elyse Kelly, CNM
• Jazmone Kelly, DO
• Peter Meagher Kelly, M.D.
• Zachary Bren'N Kelly, DC
• Agata Kelman
• Elizabeth Kelsch, BCBA
• Mary F. Kemp, LMFT
• Steven Kenis

• Social Worker in Ventura, CA
• Providers in Ventura, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.