Samuel E Kelly

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH3876 Issued in FL

Practice address

2901 W Oakland Park Blvd
Ste A1
Oakland Park, FL 33311-1243

Phone

(954) 202-9334

Fax

(954) 202-7912

NPI assigned

Mar 29, 2010

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

Other identifiers 2

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.

• Dynamic Healthcare Providers

  • Community/Behavioral Health Agency
  • Oakland Park, FL
  • NPI 1659695831
  NPD (past) Authorized official

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1669797171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 W OAKLAND PARK BLVD",
            "address_2": "STE A1",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333111243",
            "telephone_number": "954-202-9334",
            "fax_number": "954-202-7912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W OAKLAND PARK BLVD",
            "address_2": "STE A1",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333111243",
            "telephone_number": "954-202-9334",
            "fax_number": "954-202-7912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SAMUEL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-29",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH3876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "676033396",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "676033398",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justine Kelderhouse, A.R.N.P.
• Kellerman Family Chiropractic Inc
• Douglas Paul Kellerman, D.C.
• Cynthia Ellen Kelley, RNFA
• Regina Rosanwalde Kelly-Scurry, PH.D.
• Patrick Jarret Kenney, D.O.
• Evan Kern, DPT
• Kevin a Ohayon DO PA
• Amber Khan, M.S.
• Hina Khan

• Mental Health Counselor in Oakland Park, FL
• Providers in Oakland Park, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.