Individual provider Active NPI

Teresa Kelley, CSW

  • Clinical Social Worker
  • Palm Harbor, FL
National Provider Identifier
1407261969
Registry record updated Jun 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW-8168 Issued in FL
Practice address
350 Alternate 19 North
Suite C
Palm Harbor, FL 34683-0000
Phone
(713) 252-0887
Fax
(888) 345-7010
NPI assigned
Jun 24, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X ISW-8168 FL Primary

Addresses

Primary practice location

350 Alternate 19 North
Suite C
Palm Harbor, FL 34683-0000

Mailing address

3825 Henderson Blvd
405
Tampa, FL 33629-5037
Phone (713) 252-0887

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

LicenseStateTypeSpecialty
ISW-8168FLMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1407261969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 HENDERSON BLVD",
            "address_2": "405",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336295037",
            "telephone_number": "713-252-0887",
            "fax_number": "877-957-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 ALTERNATE 19 NORTH",
            "address_2": "SUITE C",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346830000",
            "telephone_number": "713-252-0887",
            "fax_number": "888-345-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "TERESA",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-24",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "ISW-8168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Harbor, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.