Kelle M Kenzik, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089375 Issued in NY

Practice address

2009 Bodanyi PL
Ronkonkoma, NY 11779-6531

Phone

(631) 621-8485

NPI assigned

Dec 5, 2018

Sex

Female

Sole proprietor

No

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)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sohomd.kellekenzik@157389.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Harmony Heights School

  • Voluntary or Charitable Agency
  • East Norwich, NY
  • NPI 1790143873
  NPD (past)

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

{
    "created_epoch": "1543968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637971200000",
    "number": "1578034336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 BODANYI PL",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117796531",
            "telephone_number": "631-621-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 BODANYI PL",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117796531",
            "telephone_number": "631-621-8485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENZIK",
        "first_name": "KELLE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-05",
        "last_updated": "2021-11-27",
        "certification_date": "2021-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "089375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Keenan
• Scott Keller, DC
• Erin Elizabeth Kelly
• Jennifer Eileen Kelly
• Michele Ann Kelly, CPNP NPP
• George Kerrigan
• Alexander John Ketterer
• Ayesha Khatri
• June Kiefer, MSN CS NPP
• Sophia P Kim

• Clinical Social Worker in Ronkonkoma, NY
• Providers in Ronkonkoma, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.

Verify at the official NPI Registry.