Kelley Bothe, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1018767 Issued in MA

Practice address

17 Simon Willard LN
Concord, MA 01742-1644

Phone

(781) 277-7687

NPI assigned

Apr 11, 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 1

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, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1740403351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 SIMON WILLARD LN",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017421644",
            "telephone_number": "781-277-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 SIMON WILLARD LN",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017421644",
            "telephone_number": "781-277-7687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTHE",
        "first_name": "KELLEY",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1018767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "PO6052",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn Norris Boland, R.PH.
• Sara M. Bolton, MD
• Jamie Bond, M.D.
• Dana A Booth, DMD
• Boston Functional Nutrition
• Anya M Botman
• Karen Louise Bougas, MD MPH
• Emily McCoy Bouley, M.D.
• Cailey Boumil
• Kathryn E Bowers, MD

• Clinical Social Worker in Concord, MA
• Providers in Concord, 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 5, 2022; 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.