Active NPI
Maria Teresa Kelley, LCSW
- Social Worker
- San Diego, CA
National Provider Identifier
1649365438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LCS 22990
- Practice address
- 3665 Kearny Villa Rd
Suite 165
San Diego, CA 92123-1953 - Phone
- (858) 966-5832
- Fax
- (858) 966-8470
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LCS 22990 | CA | Primary |
Addresses
Primary practice location
3665 Kearny Villa Rd
Suite 165
San Diego, CA 92123-1953
Mailing address
3020 Childrens Way
MC 5018
San Diego, CA 92123-4223
Phone (858) 966-5832
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2017 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 22990 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300406400000",
"number": "1649365438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3020 CHILDRENS WAY",
"address_2": "MC 5018",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234223",
"telephone_number": "858-966-5832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3665 KEARNY VILLA RD",
"address_2": "SUITE 165",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231953",
"telephone_number": "858-966-5832",
"fax_number": "858-966-8470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "MARIA",
"middle_name": "TERESA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2011-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "LCS 22990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.