Individual provider Active NPI

Kati Kelleher

  • Clinical Social Worker
  • Los Angeles, CA
National Provider Identifier
1821530486
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ASW63102 Issued in CA
Practice address
4211 Avalon Blvd
Los Angeles, CA 90011-5622
Phone
(323) 233-0425
Fax
(323) 232-2366
NPI assigned
Nov 14, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X ASW63102 CA Primary

Addresses

Primary practice location

4211 Avalon Blvd
Los Angeles, CA 90011-5622

Mailing address

4211 Avalon Blvd
Los Angeles, CA 90011-5622
Phone (323) 233-0425

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20210616001992 CA Practitioner - Clinical Social Worker 4688074404 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW63102CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Soultenders, Inc. CurrentSince Mar 12, 2021 Accepting new patients

Locations

41 E Foothill Blvd
Ste 102
Arcadia, CA 91006
Phone (626) 701-4249

1605 Hope St
Ste 350
South Pasadena, CA 91030
Phone (626) 414-5606

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.

NPI Registry JSON

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

{
    "created_epoch": "1479081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512950400000",
    "number": "1821530486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900115622",
            "telephone_number": "323-233-0425",
            "fax_number": "323-232-2366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900115622",
            "telephone_number": "323-233-0425",
            "fax_number": "323-232-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "KATI",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-14",
        "last_updated": "2017-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW63102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.