Active NPI
Shannon Kelly, LICSW
- Social Worker
- Boston, MA
National Provider Identifier
1366929747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 125829
- Practice address
- 150 S Huntington Ave
Social Work Services (122)
Boston, MA 02130 - Phone
- (774) 826-3570
- NPI assigned
- Jul 27, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 125829 | MA | |
| Social Worker | 104100000X | 125829 | MA | Primary |
| Social Worker | 104100000X | 225686 | MA |
Addresses
Primary practice location
150 S Huntington Ave
Social Work Services (122)
Boston, MA 02130
Mailing address
150 S Huntington Ave
Social Work Services (122)
Boston, MA 02130
Other practice location 1
1400 Vfw Pkwy
West Roxbury, MA 02132-4927
Phone (857) 203-5291
Other practice location 2
675 Paramount Dr
Raynham, MA 02767-5416
Phone (508) 880-0012
Other names 1
- Shannon Oconnor
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 |
|---|---|---|---|
| 225686 | MA | MD | Social Worker |
| 125829 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1366929747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 S HUNTINGTON AVE",
"address_2": "SOCIAL WORK SERVICES (122)",
"city": "BOSTON",
"state": "MA",
"postal_code": "02130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S HUNTINGTON AVE",
"address_2": "SOCIAL WORK SERVICES (122)",
"city": "BOSTON",
"state": "MA",
"postal_code": "02130",
"telephone_number": "774-826-3570"
}
],
"practiceLocations": [
{
"address_1": "1400 Vfw Pkwy",
"address_purpose": "LOCATION",
"city": "West Roxbury",
"state": "MA",
"postal_code": "021324927",
"country_code": "US",
"telephone_number": "857-203-5291",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "675 Paramount Dr",
"address_purpose": "LOCATION",
"city": "Raynham",
"state": "MA",
"postal_code": "027675416",
"country_code": "US",
"telephone_number": "508-880-0012",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KELLY",
"first_name": "SHANNON",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-27",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "125829",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "125829",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "225686",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "OCONNOR",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.