Active NPI
Timothy Joseph Kelly, CASAC-T , B.S, CDC
- Addiction (Substance Use Disorder) Counselor
- Poughkeepsie, NY
National Provider Identifier
1609599653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 34319
- Practice address
- 41 Page Park Dr Ste 7
Poughkeepsie, NY 12603-7501 - Phone
- (845) 486-2950
- NPI assigned
- Sep 23, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 34319 | NY | Primary |
Addresses
Primary practice location
41 Page Park Dr Ste 7
Poughkeepsie, NY 12603-7501
Mailing address
41 Page Park Dr Ste 7
Poughkeepsie, NY 12603-7501
Phone (845) 486-2950
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Tkelly@lexingtonctr.org | Health Information Exchange (HIE) |
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34319 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666137600000",
"number": "1609599653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 PAGE PARK DR STE 7",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126037501",
"telephone_number": "845-486-2950",
"fax_number": "845-486-2999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 PAGE PARK DR STE 7",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126037501",
"telephone_number": "845-486-2950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "TIMOTHY",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "CASAC-T , B.S, CDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-23",
"last_updated": "2022-10-19",
"certification_date": "2022-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "34319",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Tkelly@lexingtonctr.org",
"affiliation": "N",
"endpointDescription": "Secure Email with Employer",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Consented release of information to client affiliations",
"address_1": "41 Page Park Dr Ste 7",
"city": "Poughkeepsie",
"state": "NY",
"country_code": "US",
"postal_code": "126037501",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Poughkeepsie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.