Active NPI
Kelly Marie McCormick, L.C.S.W.
- Clinical Social Worker
- New Haven, CT
National Provider Identifier
1912211749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 006647
- Practice address
- 1450 Chapel St
2ND Floor- Haelen Center
New Haven, CT 06511-4405 - Phone
- (203) 789-5108
- Fax
- (203) 867-5241
- NPI assigned
- Aug 4, 2010
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 006647 | CT | Primary |
Addresses
Primary practice location
1450 Chapel St
2ND Floor- Haelen Center
New Haven, CT 06511-4405
Mailing address
1450 Chapel St
New Haven, CT 06511-4405
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006647 | CT | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, Inc. | Clinical | 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, 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": "1280880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280880000000",
"number": "1912211749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1450 CHAPEL ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065114405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 CHAPEL ST",
"address_2": "2ND FLOOR- HAELEN CENTER",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065114405",
"telephone_number": "203-789-5108",
"fax_number": "203-867-5241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "KELLY",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-04",
"last_updated": "2010-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "006647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.