Kevin Patrick Kelly, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13200 Issued in MN

Practice address

241 Cleveland Ave S
Suite B3
Saint Paul, MN 55105-1208

Phone

(651) 698-2773

Fax

(651) 698-2776

NPI assigned

Jun 16, 2006

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244332800000",
    "number": "1730123795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 CLEVELAND AVE S",
            "address_2": "SUITE B3",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051208",
            "telephone_number": "651-698-2773",
            "fax_number": "651-698-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 CLEVELAND AVE S",
            "address_2": "SUITE B3",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051208",
            "telephone_number": "651-698-2773",
            "fax_number": "651-698-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KEVIN",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2009-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "13200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "62-76668",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502473100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "91G35KE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret B Kellogg, M.A., L.P.
• Amy Marie Kelly, M.D.
• Brittany Rae Kelly, PA-C
• Candice Marie Kelly, RN
• Jody Lehua Kelly, CCC-SLP
• Maureen Kelly, MSW, LICSW
• Peter H Kelly, MD
• Steven Robert Kelly
• Tara Lee Kelly, MD
• Rachel Kay Kelm, PA-C

• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2009; 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.