Kelly-Ann Monique Fairweather, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SL05672000 Issued in NJ

Practice address

210 E Main St Ste 105
Middletown, NY 10940-4038

Phone

(845) 566-0286

NPI assigned

Jun 25, 2011

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 NY

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

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Therapist Without Borders

  • Clinical Social Worker
  • Middletown, NY
  • NPI 1386155240
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1308960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516147200000",
    "number": "1275829442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 LENOX PL",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109405526",
            "telephone_number": "347-512-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST STE 105",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109404038",
            "telephone_number": "845-566-0286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRWEATHER",
        "first_name": "KELLY-ANN",
        "middle_name": "MONIQUE",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-25",
        "last_updated": "2018-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL05672000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Exceldent of Orange/Sullivan, LLP
• Exclusive PT PC
• Eye to Eye Vision Center
• Kanayo Eze, NP
• Damien T Faillace, PA-C
• Brenda Fajarda, RPH
• Marissa Fajardo
• Kisha Marie Falcon
• Justin Michael Fallacaro, PA-C
• Family Empowerment Council, Inc.

• Social Worker in Middletown, NY
• Providers in Middletown, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.