Mollyrose Kelly, MA, LCPC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

180.012855 Issued in IL

Practice address

4711 Golf Rd Ste 1200
Skokie, IL 60076-1200

Phone

(847) 563-0440

NPI assigned

Sep 5, 2018

Last updated

May 4, 2020By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Collaborative Behavioral Health LLCGroup PAC ID 9739442369, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Collaborative Behavioral Health LLC

  • Clinical Psychologist
  • Skokie, IL
  • NPI 1194190520
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588550400000",
    "number": "1386126449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD STE 1200",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761200",
            "telephone_number": "847-563-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD STE 1200",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761200",
            "telephone_number": "847-563-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MOLLYROSE",
        "credential": "MA, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-05",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "180.012855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "180.012855",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPARTMENT OF PUBLIC HEALTH",
            "identifier": "178.012734",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Avila Keeler, PA-C
• Katrina Margaret Keithley, PA-C
• Christopher Keller
• Francine M Kelley
• Caitlin Marie Kelly, PA-C
• Carrie Kempler, LSW, MPH
• Stephanie R Kennedy-Mallum, MSN, APN, FNP-BC
• Sarah Anne Kennedy, PA-C
• Courtney Lee Kentala, PA-C
• Kenwood Healthcare Center Inc

• Clinical Psychologist in Skokie, IL
• Providers in Skokie, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.