Active NPI
Joelle Ann Kelly, PHD
- Clinical Psychologist
- Brewster, MA
National Provider Identifier
1598801920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY4274
- Practice address
- 23 Bay State Court
Brewster, MA 02631-2120 - Phone
- (508) 430-0589
- Fax
- (508) 430-5207
- NPI assigned
- Jan 30, 2007
- Last updated
- Jul 8, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY4274 | MA | Primary |
| Clinical Psychologist | 103TC0700X | PS0595 | ME |
Addresses
Primary practice location
23 Bay State Court
Brewster, MA 02631-2120
Mailing address
23 Bay State Court
Brewster, MA 02631-2120
Phone (508) 430-0589
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0517879 | Medicaid | MA | |
| 103041 | Other | VALUE OPTIONS INC HMO NEW | |
| 13445513 | Other | MAGELLAN BEHAVIORAL HEALT | |
| 0007491474 | Other | AETNA | |
| 005530 | Other | PACIFICARE OLD HPHC VALUE | |
| W04483 | Other | MA | BCBS MA |
| KEW04483 | Other | MA | BCBS INDEMNITY |
| 460402 | Other | TUFTS HEALTH CARE |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY4274 | MA | MD | Clinical Psychologist |
| PS0595 | ME | MD | Clinical Psychologist |
| 4274 | MA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598801920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 BAY STATE COURT",
"city": "BREWSTER",
"state": "MA",
"postal_code": "026312120",
"telephone_number": "508-430-0589",
"fax_number": "508-430-5207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 BAY STATE COURT",
"city": "BREWSTER",
"state": "MA",
"postal_code": "026312120",
"telephone_number": "508-430-0589",
"fax_number": "508-430-5207"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOELLE",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "PSY4274",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "ME",
"license": "PS0595",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0517879",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS INC HMO NEW",
"identifier": "103041",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN BEHAVIORAL HEALT",
"identifier": "13445513",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007491474",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE OLD HPHC VALUE",
"identifier": "005530",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "W04483",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDEMNITY",
"identifier": "KEW04483",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH CARE",
"identifier": "460402",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Brewster, MA
- Jacs Ops III, Inc (EPOCH Assisted Living of Brewster)
- Jennifer Smith LMHC LLC
- Faith Lynne Kapolis, R.D.H.
- Maureen Melinda Keanebottino, RN, CT, CGE, COUNSEL
- Leslie Adrienne Kelley
- Kerri Lynn Kelly, NBC-HWC
- Marla Nelson Ker, LCSW-C AND LICSW
- Jong Woo Kim
- Kimberly Fitzgerald, Licsw Inc
- KM Acupuncture, PLLC (Blue Thistle Acupuncture and Herbal Medicine)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.