Sean F. Kelly, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1698 Issued in MA

Practice address

20 Park PLZ
Suite 452
Boston, MA 02116-4303

Phone

(617) 792-7479

NPI assigned

Jan 23, 2007

Last updated

May 27, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464307200000",
    "number": "1215081526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WOODLAND RD",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019152747",
            "telephone_number": "617-792-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PARK PLZ",
            "address_2": "SUITE 452",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021164303",
            "telephone_number": "617-792-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SEAN",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2016-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "1698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "W0175925793",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER ID",
            "identifier": "W01759",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0504513",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul J Kelly, M.D.
• Prabhjit Kaur Kelly, OD
• Rebecca Kelly, FNP-C
• Sarah Kelly
• Sarah E Kelly
• Sean P Kelly, M.D.
• Shannon Kelly, LICSW
• Shawn Hamilton Kelly, MD
• Siobhan Elizabeth Kelly
• Susan E Kelly, M.D.

• Clinical Psychologist in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2016; 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.