Jacalyn P Kelly, LCSW
Individual provider Active NPI Social Worker · Orchard Park, NY
NPI 1447322995 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1447322995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 0543871 (NY)
- Practice address
- 3065 Southwestern Boulevard
Suite 204
Orchard Park, NY 14127 - Phone
- (716) 675-9232
- Fax
- (716) 675-9217
- NPI assigned
- Nov 13, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1996
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
300 Ctr Rd
West Seneca, NY 14224-1946
Phone (716) 471-0864
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170307000224 | NY | Practitioner - Clinical Social Worker | 8729362942 | Practice locations: West Seneca, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0543871 | NY | MD | Social Worker |
| 054387 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anthony F Bongiovanni | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 0543871 | NY | Yes |
Addresses
Primary practice location
3065 Southwestern Boulevard
Suite 204
Orchard Park, NY 14127
Mailing address
315 Alberta Drive
Suite 211
Amherst, NY 14226
Phone (716) 837-6705
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00026422101 | Other | UNIVERA | |
| 000540315001 | Other | BLUE CROSS | |
| 6212551 | Other | INDEPENDENT HEALTH |
Other providers in Orchard Park, NY
- Brooke Elizabeth Kelley
- Geraldine K Kelley
- John Joseph Kelley
- Nancy Marie Kells
- Grace Katherine Kelly
- Janet Elaine Kelly
- Kenneth J Guth MD PC
- Rochelle Kenny
- Jean Marie Kersten
- Ahmed Khattab
All providers in Orchard Park, NY · Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.