Stephanie Lyn Kelly

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT102784 Issued in CA

Practice address

2258 Camino Ramon
San Ramon, CA 94583-1353

Phone

(925) 399-8075

NPI assigned

Oct 16, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1780012484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4264 MABEL AVE",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945463547",
            "telephone_number": "925-399-8075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2258 CAMINO RAMON",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945831353",
            "telephone_number": "925-399-8075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5820 Stoneridge Mall Rd Ste 219",
            "address_purpose": "LOCATION",
            "city": "Pleasanton",
            "state": "CA",
            "postal_code": "945883200",
            "country_code": "US",
            "telephone_number": "925-399-8075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "STEPHANIE",
        "middle_name": "LYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-16",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT102784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rina Asako Kawamura
• Mahmood Reza Kazemi, M.D.
• Mustafa Michael Kazemi, MD
• Caroline Keighran, M.S., CCC-SLP
• Erin Kellar-Hill
• Valerie Kelsey
• Alicia V Kenion-Cox
• John Patrick Kennedy, M.A., MFT
• Jasmine Amanda Kerns
• Casey Kerr, LEP

• Marriage & Family Therapist in San Ramon, CA
• Providers in San Ramon, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.