Kelly Poole, LMHC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

37PC00890200 Issued in NJ

Practice address

11 Paterson Ave
Midland Park, NJ 07432-1829

Phone

(201) 213-8212

NPI assigned

Oct 6, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729987200000",
    "number": "1427655117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 PATERSON AVE",
            "city": "MIDLAND PARK",
            "state": "NJ",
            "postal_code": "074321829",
            "telephone_number": "201-213-8212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 PATERSON AVE",
            "city": "MIDLAND PARK",
            "state": "NJ",
            "postal_code": "074321829",
            "telephone_number": "201-213-8212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "KELLY",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-06",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "010737",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NJ",
            "license": "37PC00890200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Midland Park, NJ
• Providers in Midland Park, NJ by specialty
• Marriage & Family Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.

Verify at the official NPI Registry.