Kelly Gravino Russell, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

110340 Issued in MA

Practice address

16 Bush Hill Rd
Ipswich, MA 01938-1642

Phone

(978) 810-8397

NPI assigned

Sep 13, 2006

Sex

Female

Sole proprietor

Yes

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 MA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Gross Young Enterprises, Inc

  dba Leni Gross Young, MA, LMHC

  • Mental Health Counselor
  • Peabody, MA
  • NPI 1891017430
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1336244763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 BUSH HILL RD",
            "city": "IPSWICH",
            "state": "MA",
            "postal_code": "019381642",
            "telephone_number": "978-810-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 BUSH HILL RD",
            "city": "IPSWICH",
            "state": "MA",
            "postal_code": "019381642",
            "telephone_number": "978-810-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KELLY",
        "middle_name": "GRAVINO",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "110340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erinn Ridge
• Robillard Dental, LLC
• Gregory Rodrigues
• Joel J Rogge, ED.D.
• Rachael M Ruiz, RN
• Richard Scott Russell, LICSW
• Michelle Rust
• Elizabeth Ryan, MS OTR/L
• Julie M. Ryan
• Katherine Ryan, LMHC, LCPC

• Clinical Social Worker in Ipswich, MA
• Providers in Ipswich, 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 Jun 29, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.