Kellyanne Brady, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

006630 Issued in NY

Practice address

425 2ND Ave
Massapequa Park, NY 11762-1500

Phone

(718) 406-3656

NPI assigned

Jan 15, 2019

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569715200000",
    "number": "1780158485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 2ND AVE",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117621500",
            "telephone_number": "718-406-3656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 2ND AVE",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117621500",
            "telephone_number": "718-406-3656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Massapequa Park",
            "state": "NY",
            "postal_code": "117621500",
            "country_code": "US",
            "telephone_number": "718-406-3656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 Hempstead Ave Ste 248",
            "address_purpose": "LOCATION",
            "city": "Rockville Centre",
            "state": "NY",
            "postal_code": "115704034",
            "country_code": "US",
            "telephone_number": "516-323-3854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADY",
        "first_name": "KELLYANNE",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-15",
        "last_updated": "2019-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "006630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Bonanno, OTR/L
• Lauren Borgersen
• Michele Marie Borget-de Vos, LCSW-R
• Elizabeth Marie Bourne, LCSW
• Luz Ann Bove, MS, OTR/L
• Kevin Scott Bragg, LCSW CASAC
• Rosalynn Bristol
• Yvonne Theresa Bristow, RN/GNP
• Nicole Brock
• Erica Lori Brown, MS, ED.

• Mental Health Counselor in Massapequa Park, NY
• Providers in Massapequa Park, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.