Kevin G Kelly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R0247451 Issued in NY

Practice address

527 Western Ave
Albany, NY 12203-1721

Phone

(518) 438-7745

NPI assigned

Apr 17, 2007

Sex

Male

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)

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.

• Pine Hills Family Medicine, PLLC

  • Family Medicine Physician
  • Albany, NY
  • NPI 1437339793
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669697231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2136 MORROW AVE",
            "city": "NISKAYUNA",
            "state": "NY",
            "postal_code": "123092334",
            "telephone_number": "518-393-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 WESTERN AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122031721",
            "telephone_number": "518-438-7745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "G",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0247451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia O. Kelley, NPP
• Tenequa K Kelley
• Dara Kelly
• Joseph A Kelly, MD
• Katherine E Kelly, PSY.D
• Mary A Kelly, RN
• Matthew Ryer Kelly, M.D.
• Shaelynn Kelly
• Susan M Kelly
• Yvette N Kelly, MSED

• Clinical Social Worker in Albany, NY
• Providers in Albany, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.