Kelly Anne Mayberry

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

016025 Issued in NY

Practice address

170A N Oak St
Massapequa, NY 11758-3047

Phone

(516) 404-8692

NPI assigned

May 8, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1746662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1841080421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170A N OAK ST",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117583047",
            "telephone_number": "516-404-8692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170A N OAK ST",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117583047",
            "telephone_number": "516-404-8692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-08",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "38714",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "016025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirley Mathew, MD
• Amanda Emily Matises
• Maureen Kaley PHD
• Lindsay Maurin
• Mauro Gasparini, M.D., P.C.
• Adama Maynard, LMT
• Paul W Mazzei, DDS
• Tamara McAtamney
• Quianna Angela McBean, LPN
• Laura McCabe

• Mental Health Counselor in Massapequa, NY
• Providers in Massapequa, 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 May 8, 2025; 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.