Active NPI
Ida Rockwell-Kettles
- Mental Health Counselor
- Rochester, NY
National Provider Identifier
1568034452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- P108976
- Practice address
- 510 Clinton SQ
Rochester, NY 14604-1700 - Phone
- (585) 200-7106
- NPI assigned
- Jul 12, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P108976 | NY | Primary |
Addresses
Primary practice location
510 Clinton SQ
Rochester, NY 14604-1700
Mailing address
510 Clinton SQ
Rochester, NY 14604-1700
Phone (585) 204-0381
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568034452 | Other | NY | INSURANCE |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | 400304 | El-Amin-Turner Mental Health Counseling LLC | |
| CONNECT URL | 400304 |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P108976 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634256000000",
"number": "1568034452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 CLINTON SQ",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146041700",
"telephone_number": "585-204-0381",
"fax_number": "973-253-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 CLINTON SQ",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146041700",
"telephone_number": "585-200-7106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROCKWELL-KETTLES",
"first_name": "IDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-12",
"last_updated": "2021-10-15",
"certification_date": "2021-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "P108976",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INSURANCE",
"identifier": "1568034452",
"state": "NY"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "400304",
"affiliation": "Y",
"affiliationName": "El-Amin-Turner Mental Health Counseling LLC",
"address_1": "Prince Street",
"city": "Rochester",
"state": "NY",
"country_code": "US",
"postal_code": "14607",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "400304",
"affiliation": "N",
"address_1": "510 Clinton Sq",
"city": "Rochester",
"state": "NY",
"country_code": "US",
"postal_code": "146041700",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.