Individual provider Active NPI

Kelley Holiday, LCSW

  • Clinical Social Worker
  • Kingston, NY
National Provider Identifier
1669290391
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
097282 Issued in NY
Practice address
1 Family Practice Dr
Kingston, NY 12401-6449
Phone
(512) 413-4742
NPI assigned
Oct 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 097282 NY Primary

Addresses

Primary practice location

1 Family Practice Dr
Kingston, NY 12401-6449

Mailing address

64 Stephan St
Kingston, NY 12401-3030
Phone (512) 413-4742

Other names 1

  • Kelley Kochert Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250416000722 NY Practitioner - Clinical Social Worker 2961927546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Access Supports for Living IncGroup PAC ID 8729992730, 41 clinicians

Practice addresses (Care Compare)

368 Broadway
FL 2
Kingston, NY 12401-5144
Phone (845) 725-8343

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Access: Supports for Living Inc. CurrentSince Mar 17, 2025 Accepting new patients
Access: Supports for Living Inc CurrentSince Mar 17, 2025 Accepting new patients

Locations

368 Broadway
Fl 2
Kingston, NY 12401
Phone (845) 725-8343

67 Windsor Hwy
Newburgh, NY 12553
Phone (845) 562-6850

15 Fortune Rd W
Scotchtown, NY 10941
Phone (845) 673-7123

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1727740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1669290391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 STEPHAN ST",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013030",
            "telephone_number": "512-413-4742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 FAMILY PRACTICE DR",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124016449",
            "telephone_number": "512-413-4742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLIDAY",
        "first_name": "KELLEY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-01",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "097282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "KOCHERT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kingston, NY

Sources for this page

Verify at the official NPI Registry.