Active NPI
Kathryn Kellison, LCSW
- Clinical Social Worker
- Augusta, ME
National Provider Identifier
1265566244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC2584
- Practice address
- 74 Winthrop St
Augusta, ME 04330-5544 - Phone
- (207) 622-4774
- Fax
- (207) 622-4774
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- 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 | LC2584 | ME | Primary |
Addresses
Primary practice location
74 Winthrop St
Augusta, ME 04330-5544
Mailing address
74 Winthrop St
Augusta, ME 04330-5544
Phone (207) 622-4774
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 011152 | Other | ME | ANTHEM PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC2584 | ME | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265566244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "74 WINTHROP ST",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043305544",
"telephone_number": "207-622-4774",
"fax_number": "207-622-4774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 WINTHROP ST",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043305544",
"telephone_number": "207-622-4774",
"fax_number": "207-622-4774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLISON",
"first_name": "KATHRYN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "LC2584",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "011152",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.