Active NPI
Justin C Kelly
- Counselor
- West Roxbury, MA
National Provider Identifier
1447406376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 2020 Centre St
West Roxbury, MA 02132-3316 - Phone
- (781) 437-1323
- NPI assigned
- Aug 12, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary | ||
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
2020 Centre St
West Roxbury, MA 02132-3316
Mailing address
2020 Centre St
West Roxbury, MA 02132-3316
Phone (781) 437-1323
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M18708 | Other | MA | BLUE CROSS |
| 1312685 | Medicaid | MA | |
| 1312677 | Medicaid | MA | |
| 685661 | Other | MA | TUFTS |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218499200000",
"number": "1447406376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 CENTRE ST",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021323316",
"telephone_number": "781-437-1323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 CENTRE ST",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021323316",
"telephone_number": "781-437-1323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JUSTIN",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-12",
"last_updated": "2008-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "M18708",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1312685",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1312677",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "685661",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.