Individual provider Active NPI

Andrea Lee Kelly, M.A.

  • Counseling Psychologist
  • Burlington, VT
National Provider Identifier
1487935516
Registry record updated Dec 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
608 Issued in VT
Practice address
444 South Union St.
Suite 230
Burlington, VT 05401
Phone
(802) 363-9567
NPI assigned
Sep 2, 2011
Last updated
Dec 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 047.0000608 VT
Counseling Psychologist 103TC1900X 608 VT Primary

Addresses

Primary practice location

444 South Union St.
Suite 230
Burlington, VT 05401

Mailing address

444 South Union St.
Suite #230
Burlington, VT 05401
Phone (802) 363-9567

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240229003440 VT Practitioner - Mental Health Counselor 0840635876 Practice locations: Burlington, VT

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

444 S Union St
Suite 230
Burlington, VT 05401-4829
Phone (802) 363-9567

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
608VTMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Laura a. Ramirez, DC PC PastSince Nov 21, 2023 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1314921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702771200000",
    "number": "1487935516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 SOUTH UNION ST.",
            "address_2": "SUITE #230",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "05401",
            "telephone_number": "802-363-9567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 SOUTH UNION ST.",
            "address_2": "SUITE 230",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "05401",
            "telephone_number": "802-363-9567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ANDREA",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-02",
        "last_updated": "2023-12-17",
        "certification_date": "2023-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "047.0000608",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "VT",
            "license": "608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.