Kelly Anne Broderick, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

122657 Issued in MA

Practice address

152 Lynnway Ste 2C
Lynn, MA 01902-3420

Phone

(617) 982-3996

NPI assigned

Jan 7, 2013

Last updated

May 28, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, AZ2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellybroderick@tdh.allscriptsdirect.net

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.

• Healing Lotus Counseling

  dba Kelly Broderick

  • Adult Mental Health Clinic/Center
  • Boston, MA
  • NPI 1740919018
  NPD Authorized official
• Community Partners Integrated Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1669897385
  Medicare reassignment
• Leading Light Mental Health Clinic, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brockton, MA
  • NPI 1730862491

  Clinical

  NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD
• Aeon Nonprofit Training Associates, LLC

  • Adult Mental Health Clinic/Center
  • Lynn, MA
  • NPI 1376032623
  NPD (past)
• High Point Treatment Center Inc.

  • Counselor
  • New Bedford, MA
  • NPI 1518996354
  NPD (past)
• Mental Health Resources Inc

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1164131140
  NPD (past)
• Mental Health Resources Inc

  dba Housing Assistance for Arizona

  • Community/Behavioral Health Agency
  • Tucson, AZ
  • NPI 1346959277
  NPD (past)

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

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1407193758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 POLO RD APT 235",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292234425",
            "telephone_number": "207-671-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 LYNNWAY STE 2C",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019023420",
            "telephone_number": "617-982-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-07",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "122657",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Briere
• Kristen Briggs
• Barbara Haczela- Brissenden, O.T.R., L.
• Robin Sue Broady, LICSW
• Nnkesia Amabelle Brock, DOULA
• Rori Anne Brodsky
• Zhanna Bronshvayg
• Brothers & Son Comfort Care Transportation LLC
• Brown & Hung PC (Prosthetic Associates)
• Christine Elizabeth Brown, M.S.P.T.

• Clinical Social Worker in Lynn, MA
• Providers in Lynn, 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 May 28, 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.