Ginny Lynn Kelly, LICSW
Individual provider Active NPI Clinical Social Worker · Lakeville, MA
NPI 1619980992 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619980992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 1028860 (MA)
- Practice address
- 104 Charles Eldridge Dr
Lakeville, MA 02347 - Phone
- (508) 947-1683
- Fax
- (508) 947-1684
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Tranquil Mind and Wellness, Inc
Practice addresses (Care Compare)
6 Alberta LN
Lakeville, MA 02347-1864
Phone (508) 947-1683
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070815000659 | MA | Practitioner - Clinical Social Worker | 5991787871 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1028860 | MA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tranquil Mind & Wellness, Inc | Current |
Accepting new patients |
Locations
104 Charles Eldridge Rd
Lakeville, MA 02347
Phone (508) 813-3892
109 Rhode Island Rd
Ste B
Lakeville, MA 02347
Phone (508) 947-1683
47 E Grove St
Middleboro, MA 02346
Phone (508) 927-1955
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1028860 | MA | Yes |
Addresses
Primary practice location
104 Charles Eldridge Dr
Lakeville, MA 02347
Mailing address
104 Charles Eldridge Dr
Lakeville, MA 02347
Phone (508) 947-1683
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1890140 | Medicaid | MA | |
| P07349 | Other | BCBS | |
| 2023330 | Other | CIGNA | |
| 33106235301 | Other | PACIFICARE | |
| 349493 | Other | MAGELLAN | |
| 469030 | Other | TUFTS | |
| 159505 | Other | VALUE OPTIONS | |
| 410720 | Other | BLUE CHIP |
Other providers in Lakeville, MA
- Frannie Hsu
- Illumination Psychotherapy Services, LLC.
- In Sight Healing and Counseling LLC
- Island Terrace, Inc.
- Rhiannon Jackson
- Ghassan A Khoury
- Cherie Kish
- Jennifer L Koester
- Judy Kohut
- Lakeside Mental Health, PLLC
All providers in Lakeville, MA · Clinical Social Worker in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.