Kelly Obrien Licensed Clinical Social Worker

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

KELLY OBRIEN LICENSED CLINICAL SOCIAL WORKER

Practice address

365 Summerhaven Dr N
East Syracuse, NY 13057-3130

Phone

(315) 325-8619

NPI assigned

Feb 7, 2024

Organization subpart

No

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

Authorized official

Name

Kelly Theresa O'Brien, LCSWNPI 1427426063

Title

Sole MBR

Phone

(315) 325-8619

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Theresa O'Brien, LCSW

  • Clinical Social Worker
  • East Syracuse, NY
  • NPI 1427426063
  NPD Authorized official

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

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1780448183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 SUMMERHAVEN DR N",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573130",
            "telephone_number": "315-325-8619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 SUMMERHAVEN DR N",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573130",
            "telephone_number": "315-325-8619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY OBRIEN LICENSED CLINICAL SOCIAL WORKER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "THERESA",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "315-325-8619",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sue Ann Kayne, PT
• Megan Keating, PT
• Kristin M. Keim, MSTSHH
• Michael B Kelleher, MD
• Lynn Doris Kells, CCC-SLP
• Lauren Kennedy, MS, CAS
• Melinda Kernan
• Christine Khanzadian
• Elizabeth M Kiggins, PT
• Sang W Kim, MD

• Clinical Social Worker in East Syracuse, NY
• Providers in East Syracuse, 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 Feb 7, 2024; 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.