Active NPI
Jeremy John Kelly
- Counselor
- Rochester, NY
National Provider Identifier
1295696714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 130139
- Practice address
- 1100 Long Pond Rd Ste 222
Rochester, NY 14626-1177 - Phone
- (585) 385-6030
- NPI assigned
- Nov 24, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 130139 | NY | Primary |
Addresses
Primary practice location
1100 Long Pond Rd Ste 222
Rochester, NY 14626-1177
Mailing address
1100 Long Pond Rd Ste 222
Rochester, NY 14626-1177
Phone (585) 385-6030
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 |
|---|---|---|---|
| 130139 | NY | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767484800000",
"number": "1295696714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 LONG POND RD STE 222",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146261177",
"telephone_number": "585-385-6030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 LONG POND RD STE 222",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146261177",
"telephone_number": "585-385-6030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JEREMY",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-11-24",
"last_updated": "2026-01-04",
"certification_date": "2026-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NY",
"license": "130139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.