Cynthia Ann Kelly, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LSW0000005191 Issued in TN

Practice address

600 E Unaka Ave
Johnson City, TN 37601-4035

Phone

(423) 330-7943

Fax

(877) 489-8209

NPI assigned

Aug 5, 2010

Last updated

Feb 21, 2014By the provider in NPPES

Sex

Female

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392940800000",
    "number": "1730493438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 N MAIN AVE",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376507995",
            "telephone_number": "423-330-7943",
            "fax_number": "877-489-8209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E UNAKA AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014035",
            "telephone_number": "423-330-7943",
            "fax_number": "877-489-8209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CYNTHIA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-05",
        "last_updated": "2014-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "LSW0000005191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520556",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Lee Keith, O.D.
• Michael Allen Keith, O.D.
• Raquel Keithley, P.T. D.P.T P.C.S
• Krysten Kelch, LCSW
• Danny Kellum, LPC
• Kenneth Raymond Kelly, DDS
• Kristi Karen Kelly, BSW
• Olivia Kelly
• Elizabeth Kennedy, BS
• Kenneth R. Kelly, D.D.S, P.C.

• Clinical Social Worker in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; 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.