Shannon Kelly, LICSW, CPCC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111493 Issued in MA

Practice address

875 Massachusetts Ave
#61
Cambridge, MA 02139-3067

Phone

(617) 642-2371

NPI assigned

Apr 3, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1508109083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 CENTRE ST",
            "address_2": "#6",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021392113",
            "telephone_number": "617-642-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MASSACHUSETTS AVE",
            "address_2": "#61",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393067",
            "telephone_number": "617-642-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHANNON",
        "name_prefix": "Ms.",
        "credential": "LICSW, CPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-03",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph W Kelly, LMHC
• Lindsey Rae Kelly, PA-C
• Michelle Marie Kelly, ATC
• Patrick Francis Kelly, MD
• Sarah J Kelly, LICSW
• Susan Malkin Kelly, MD
• Matthew Kelsey, LICSW
• Peter V Kelsey, LICSW
• Gwendolyn Anne Kelso, PH.D.
• Michael Donnell Kelso Jr., MD

• Clinical Social Worker in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; 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.