Kellie Martin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

084444-1 Issued in NY

Practice address

10 Hickory St
Central Islip, NY 11722-4704

Phone

(631) 335-9573

NPI assigned

Jul 11, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, WA2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelliemartin@tdh.allscriptsdirect.net

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.

• Long Island Elder Care LCSW PLLC

  • Social Worker
  • Smithtown, NY
  • NPI 1295763852
  Medicare reassignment NPD
• Mindful Therapy Group PC

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678
  Medicare reassignment NPD
• Pick Your Pathway Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Central Islip, NY
  • NPI 1588371215
  NPD Authorized official
• CH MH Services (Ma), LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Peabody, MA
  • NPI 1639817828
  NPD
• CH MH Services Ma, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Peabody, MA
  • NPI 1083593024
  NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD
• CH MH Services (Ny), LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Levittown, NY
  • NPI 1275279176
  NPD (past)
• CH MH Services (NM), LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Santa Fe, NM
  • NPI 1386417012
  NPD (past)

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1770935116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 HICKORY ST",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117224704",
            "telephone_number": "631-335-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HICKORY ST",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117224704",
            "telephone_number": "631-335-9573"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6505 216th St SW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Mountlake Terrace",
            "state": "WA",
            "postal_code": "980432089",
            "country_code": "US",
            "telephone_number": "425-640-7009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KELLIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2024-05-15",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61407523",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "08-4444",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "084444-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khamattie Mahase
• Ithamar Malave
• Julianna Marince, LMSW
• Marie Yanick Marius Dubois, REGISTERED NURSE
• Emmy Yanize Marquez
• Veera Martin
• Andrea Martinez Villalobos, RPA-C
• Aileen Martinez
• Wanda Yvette Matthew
• Eileen Mausler, RN

• Clinical Social Worker in Central Islip, NY
• Providers in Central Islip, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.