Active NPI
Kelly Elizabeth Moore, MS, NCC
- Mental Health Counselor
- Boston, MA
National Provider Identifier
1801393954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 418 Commonwealth Ave
Boston, MA 02215-2801 - Phone
- (617) 501-1814
- NPI assigned
- Apr 6, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
418 Commonwealth Ave
Boston, MA 02215-2801
Mailing address
418 Commonwealth Ave
Boston, MA 02215-2801
Phone (617) 501-1814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinical Therapeutic Support LCSW PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- New York, NY
- NPI 1851805345
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522972800000",
"number": "1801393954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "418 COMMONWEALTH AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022152801",
"telephone_number": "617-501-1814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418 COMMONWEALTH AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022152801",
"telephone_number": "617-501-1814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KELLY",
"middle_name": "ELIZABETH",
"credential": "MS, NCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-06",
"last_updated": "2018-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.