Judith M. Kelley, MSW, LICSW, LADC1

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111003 Issued in MA

Practice address

15 Davedon Dr
East Falmouth, MA 02536-5046

Phone

(508) 457-4955

Fax

(508) 457-4955

NPI assigned

Jan 4, 2007

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 2

Medicare fee-for-service enrollment

Enrolled in MA

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.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Gosnold, Inc.Group PAC ID 5991776627, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Gosnold, Inc.

  • Children's Substance Abuse Rehabilitation Facility
  • Falmouth, MA
  • NPI 1639219314
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740337898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 302",
            "city": "FALMOUTH",
            "state": "MA",
            "postal_code": "025410302",
            "telephone_number": "508-457-4955",
            "fax_number": "508-457-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 DAVEDON DR",
            "city": "EAST FALMOUTH",
            "state": "MA",
            "postal_code": "025365046",
            "telephone_number": "508-457-4955",
            "fax_number": "508-457-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "JUDITH",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "MSW, LICSW, LADC1",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICSW",
            "identifier": "111003",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADC 1",
            "identifier": "1106",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Goldberg
• Suzanne Hauptmann, LICSW
• Susan Debra Hood, LICSW
• Cathleen Rose Jeffers, MAT, BCBA, LABA-MA
• Jonelle Olivia Kelley, RN
• Nancy Axon Kerrigan, LICSW
• Victoria M Klein, REGISTERED NURSE
• Elizabeth Ashton Landers, M.A. LPC,
• Rebecca Jean Lawrence, N.D.
• Katherine Larue Leblanc

• Clinical Social Worker in East Falmouth, MA
• Providers in East Falmouth, MA by specialty
• Clinical Social Worker in Massachusetts

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.