Individual provider Active NPI

Kelly L Burkett, MS, CRC, LMHC

  • Rehabilitation Counselor
  • Syracuse, NY
National Provider Identifier
1902041759
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation CounselorTaxonomy code 225C00000X
License
00108513 Issued in NY
Practice address
813 Fay Rd
Syracuse, NY 13219-3009
Phone
(315) 488-3804
NPI assigned
Dec 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 004778 NY
Rehabilitation Counselor 225C00000X 00108513 NY Primary

Addresses

Primary practice location

813 Fay Rd
Syracuse, NY 13219-3009

Mailing address

4939 Ernest Way
Clay, NY 13041
Phone (585) 739-2492

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

State licenses

LicenseStateTypeSpecialty
004778NYMDAcupuncturist
00108513NYMDRehabilitation Counselor

NPI Registry JSON

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

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318982400000",
    "number": "1902041759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4939 ERNEST WAY",
            "city": "CLAY",
            "state": "NY",
            "postal_code": "13041",
            "telephone_number": "585-739-2492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 FAY RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132193009",
            "telephone_number": "315-488-3804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKETT",
        "first_name": "KELLY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MS, CRC, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-09",
        "last_updated": "2011-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "004778",
            "primary": false
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": "NY",
            "license": "00108513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.