Individual provider Active NPI

Kelsey Marie Miller, LCSW

  • Clinical Social Worker
  • Syracuse, NY
National Provider Identifier
1790371870
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
096147 Issued in NY
Practice address
1065 James St
Syracuse, NY 13203-2787
Phone
(315) 800-9003
NPI assigned
Dec 14, 2020
Last updated
May 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU
Clinical Social Worker 1041C0700X 096147 NY Primary

Addresses

Primary practice location

1065 James St
Syracuse, NY 13203-2787

Mailing address

1065 James St
Syracuse, NY 13203-2787
Phone (315) 800-9003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20251211002334 NY Practitioner - Clinical Social Worker 5092209585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Optum Cir
Eden Prairie, MN 55344-2956

3300 James St
Suite 100
Syracuse, NY 13206-2392

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
096147NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Services of New York PC CurrentSince Sep 15, 2025 Accepting new patients
Psychiatry Services of New York, P.C. Clinical CurrentSince Sep 15, 2025 Accepting new patients

Locations

3300 James St
Ste 100
Syracuse, NY 13206
Phone (315) 671-2202

3300 James St
Ste 101
Syracuse, NY 13206

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/28623/brand/6/csg/1/fhir/r4
  • Direct secure messaging: kelsey.miller.1@28623.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1790371870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032787",
            "telephone_number": "315-800-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032787",
            "telephone_number": "315-800-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KELSEY",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-14",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "096147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.