Kellie Illmensee, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05738600 Issued in NJ

Practice address

268 Pelican Rd
Middletown, NJ 07748-3040

Phone

(732) 610-8396

NPI assigned

Jul 28, 2017

Reactivated

Oct 14, 2022

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

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.

• Coastal Community Counseling Services LLC

  • Clinical Social Worker
  • Middletown, NJ
  • NPI 1790292787
  NPD Authorized official

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1629592993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 PELICAN RD",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077483040",
            "telephone_number": "732-610-8396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "268 PELICAN RD",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077483040",
            "telephone_number": "732-610-8396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLMENSEE",
        "first_name": "KELLIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-28",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "deactivation_date": "2017-12-28",
        "reactivation_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05738600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Travis Hostnik, DMD
• Huntington Learning Center
• Katherine Barrett Husek, FNP
• Annmarie Huszar, SLP
• Tatsiana Iannaccio, PHARMD
• James Imbriale, M.S.ED.
• Danielle Indelicato
• Itsourtime Corp. (Home Helpers)
• Jack R. Dugo, Jr., D.C., LLC
• JBSL Sales and Consulting LLC

• Clinical Social Worker in Middletown, NJ
• Providers in Middletown, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; 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.