Active NPI
Brenda Kelleher, LCSW, LICSW
- Clinical Social Worker
- Phoenix, AZ
National Provider Identifier
1619227410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 20860 N Tatum Blvd Ste 300
Phoenix, AZ 85050-4283 - Phone
- (207) 319-9005
- NPI assigned
- Sep 19, 2012
- Last updated
- Feb 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
20860 N Tatum Blvd Ste 300
Phoenix, AZ 85050-4283
Mailing address
135 Maine St Ste a-291
Brunswick, ME 04011-2098
Phone (207) 319-9005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME, MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
47 Kopaddy TRL
Harpswell, ME 04079-3810
Phone (207) 319-9005
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- brendakelleher@tdh.allscriptsdirect.net
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Scottsdale, AZ
- NPI 1831682111
MA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675814400000",
"number": "1619227410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 MAINE ST STE A-291",
"city": "BRUNSWICK",
"state": "ME",
"postal_code": "040112098",
"telephone_number": "207-319-9005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20860 N TATUM BLVD STE 300",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850504283",
"telephone_number": "207-319-9005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEHER",
"first_name": "BRENDA",
"credential": "LCSW, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-19",
"last_updated": "2023-02-08",
"certification_date": "2023-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.