Charles J Kelly
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Garrison, NY
NPI 1508013103 · NPPES record last updated Aug 26, 2008
Key facts
- NPI
- 1508013103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 20821 (NY)
- Practice address
- 21 Franciscan Way
Garrison, NY 10524-0150 - Phone
- (845) 335-1000
- NPI assigned
- Aug 26, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20821 | NY | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St.Christopher'S Inn | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/0a1d8e09-c5b6-42c3-8311-cf5af3665cbe/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 20821 | NY | Yes |
Addresses
Primary practice location
21 Franciscan Way
Garrison, NY 10524-0150
Mailing address
PO Box 150
Garrison, NY 10524-0150
Phone (845) 335-1000
Other providers in Garrison, NY
- Rodney J Headley
- Kristen Henn
- Barbara Idczak-Krenz
- Katherine Bailey Johnson
- Matthew Johnson
- Lauranne Kristoferson
- Michelle Elena Laccetti
- Sarah Anne Lovell
- Beth Anne Luft
- Jared S Lutwyche
All providers in Garrison, NY · Addiction (Substance Use Disorder) Counselor 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 Aug 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.