Active NPI
Noreen Kelly
- Clinical Social Worker
- Shirley, NY
National Provider Identifier
1740402262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 30198
- Practice address
- 550 Montauk Hwy
Shirley, NY 11967-2114 - Phone
- (631) 852-1070
- Fax
- (631) 852-1119
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 30198 | NY | Primary |
Addresses
Primary practice location
550 Montauk Hwy
Shirley, NY 11967-2114
Mailing address
PO Box 22036
Albany, NY 12201-2036
Phone (631) 852-1070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30198 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740402262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22036",
"city": "ALBANY",
"state": "NY",
"postal_code": "122012036",
"telephone_number": "631-852-1070",
"fax_number": "631-852-1119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 MONTAUK HWY",
"city": "SHIRLEY",
"state": "NY",
"postal_code": "119672114",
"telephone_number": "631-852-1070",
"fax_number": "631-852-1119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "NOREEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "30198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shirley, NY
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.