Individual provider Active NPI

Kelly Haggerty, LCSW

  • Social Worker
  • Syracuse, NY
National Provider Identifier
1316536782
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
110276-01
Practice address
1045 James St Ste 100
Syracuse, NY 13203-2758
Phone
(315) 425-1004
NPI assigned
Jan 11, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 110276-01 Primary

Addresses

Primary practice location

1045 James St Ste 100
Syracuse, NY 13203-2758

Mailing address

14 Gifford Dr
Syracuse, NY 13219-1220
Phone (315) 383-4143

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250401001041 NY Practitioner - Clinical Social Worker 8820511744 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Resources Inc. Current Accepting new patients
Liberty Resources, Inc. CurrentSince Mar 19, 2025 Accepting new patients
Liberty Resources, Inc. CurrentSince Mar 19, 2025 Accepting new patients

Locations

1045 James St
Ste 100
Syracuse, NY 13203
Phone (315) 425-1004

1045 James St
Syracuse, NY 13203
Phone (315) 425-1004

Interoperability endpoints

  • Direct secure messaging: kelly.haggerty.p1@direct.liberty-resources.nextgenshare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1316536782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 GIFFORD DR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132191220",
            "telephone_number": "315-383-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032758",
            "telephone_number": "315-425-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGGERTY",
        "first_name": "KELLY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-11",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": "110276-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.