Kelly Stavrides, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PC016294 Issued in PA

Practice address

516 Kauffman St
Philadelphia, PA 19147-3015

Phone

(856) 433-4184

NPI assigned

May 31, 2024

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

Practice roles

Locations

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.

• Queen Village Therapy Group

  • Clinical Social Worker
  • Philadelphia, PA
  • NPI 1467155788

  Mental Health

  NPD

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

{
    "created_epoch": "1717113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1609616093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 KAUFFMAN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191473015",
            "telephone_number": "856-433-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 KAUFFMAN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191473015",
            "telephone_number": "856-433-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAVRIDES",
        "first_name": "KELLY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-31",
        "last_updated": "2024-05-31",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "PC016294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaylin Staunton
• Mia Stavarski
• Joseph Robert Stavish
• Samantha Stavola
• Thomas James Stavola, DO
• Leonard Stavropolskiy, PT
• S. William Stavropoulos, MD
• Lawrence John Stawkowski, DO
• Michael A Stawnychy, CRNP
• Vanessa Stay, LPC

• Mental Health Counselor in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Mental Health Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; 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.