Kelly D Prothero, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 26369 Issued in CA

Practice address

100 Tamal PLZ
Suite 195
Corte Madera, CA 94925-1125

Phone

(415) 497-8322

NPI assigned

Oct 25, 2006

Sex

Female

Sole proprietor

Yes

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)

Enrolled

State licenses

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306800000000",
    "number": "1225112055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 LAUREL PL",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012012",
            "telephone_number": "415-747-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TAMAL PLZ",
            "address_2": "SUITE 195",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251125",
            "telephone_number": "415-497-8322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROTHERO",
        "first_name": "KELLY",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2011-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 26369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Anne Posner, MFT
• Post Street Occupational Medicine PC
• Gordana Potrebic, PSY.D.
• Michael Eric Prentice, CCC-SLP
• Deon Pretorius, RPH
• Psychserv Medical Corporation
• Jedidiah Purses, AMFT
• Susan Theresa Quigley, MFT
• Josephine Rabb, MFT
• Hillary Green Redlin, MD

• Clinical Social Worker in Corte Madera, CA
• Providers in Corte Madera, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; 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.