Kelli O'Connor

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

200 Boston Ave Ste 1925
Medford, MA 02155-4243

Phone

(617) 869-1324

NPI assigned

Apr 30, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1710733688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 MAIN ST APT 2",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018015644",
            "telephone_number": "617-869-1324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BOSTON AVE STE 1925",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554243",
            "telephone_number": "617-869-1324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "KELLI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Solomon Chimaobim Nwachukwu, RN
• Caroline Elizabeth O'Brien, FNP-C
• Gillian Bradshaw O'Brien
• Paul R. O'Brien, EDD
• Virginia R O'Connell Ryan, LICSW
• Kathleen M O'Dea, P. A. - C.
• Chukwueloka Obionwu Jr., MD, CAQSM
• Katharine Odonoghue
• Kenechukwu Offiah
• Pius Fovie Ogagan, MD

• Mental Health Counselor in Medford, MA
• Providers in Medford, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.