Diane G Kelly, LCSW MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS11005 Issued in CA

Practice address

260 Newport Center Dr
Ste 203
Newport Beach, CA 92660-7520

Phone

(949) 244-6140

NPI assigned

May 17, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diane G Kelly Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Memory and Movement Clinic

  • Geriatric Medicine (Family Medicine) Physician
  • Newport Beach, CA
  • NPI 1447139175
  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344211200000",
    "number": "1942417035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4165 WARNER AVE",
            "address_2": "UNIT 302",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926494255",
            "telephone_number": "949-244-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 NEWPORT CENTER DR",
            "address_2": "STE 203",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607520",
            "telephone_number": "949-244-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DIANE",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "LCSW MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2012-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS11005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "LCS11005",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "KELLY",
            "middle_name": "G",
            "credential": "LCSW MSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kelli a. Fox (Golden State Hospice)
• Kelli Junker DDS Inc
• Kelli Junker DDS Inc
• Sandra Kellum, M.D.
• Kelly Kazmierski, PHD, a Psychology Corporation
• Meghan Rose Kelly, FNP-C
• Samantha Bustos Kelly, AUD
• Ruth Kembay
• Adam Rock Kendall, M.D., M.P.H.
• Lois L Kennedy, MA, LMFT

• Clinical Social Worker in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; 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.