Mary Elizabeth Kelleher, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

105438 Issued in MA

Practice address

58 Old Colony Ave
South Boston, MA 02127-2406

Phone

(617) 268-1700

Fax

(617) 268-1991

NPI assigned

Apr 11, 2006

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

Other identifiers 1

Other names 1

• Mrs. Mary Bryan Kelleher Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1295798114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MAYFAIR ST",
            "city": "NORWOOD",
            "state": "MA",
            "postal_code": "020621201",
            "telephone_number": "781-762-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 OLD COLONY AVE",
            "city": "SOUTH BOSTON",
            "state": "MA",
            "postal_code": "021272406",
            "telephone_number": "617-268-1700",
            "fax_number": "617-268-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "105438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL WORKER",
            "identifier": "KEP23687",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "KELLEHER",
            "middle_name": "BRYAN",
            "prefix": "MRS.",
            "credential": "LICSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Social Worker in South Boston, MA
• Providers in South Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.