Active NPI
Christian Patrick Kelley, LCSW
- Social Worker
- Southbridge, MA
National Provider Identifier
1659852291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 223799
- Practice address
- 176 Main St
Southbridge, MA 01550-2561 - Phone
- (508) 980-2005
- NPI assigned
- Aug 22, 2018
- Sex
- Male
- 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 | 223799 | MA | Primary |
Addresses
Primary practice location
176 Main St
Southbridge, MA 01550-2561
Mailing address
10 Mechanic St Ste 302
Worcester, MA 01608-2419
Phone (508) 792-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 223799 | MA | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534896000000",
"number": "1659852291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 MECHANIC ST STE 302",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016082419",
"telephone_number": "508-792-5400",
"fax_number": "508-831-0074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "176 MAIN ST",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "015502561",
"telephone_number": "508-980-2005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "CHRISTIAN",
"middle_name": "PATRICK",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-22",
"last_updated": "2018-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "223799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southbridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.