Active NPI
Jillian Burley Kelly, PSY.D
- Clinical Psychologist
- Wellesley, MA
National Provider Identifier
1942510318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 10185
- Practice address
- 25 Walnut St Ste 300
Wellesley, MA 02481-2145 - Phone
- (176) 286-5642
- NPI assigned
- Oct 19, 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 Psychologist | 103TC0700X | 10185 | MA | Primary |
Addresses
Primary practice location
25 Walnut St Ste 300
Wellesley, MA 02481-2145
Mailing address
25 Walnut St Ste 300
Wellesley, MA 02481-2145
Phone (617) 286-5002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 20, 2024 through Feb 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711584000000",
"number": "1942510318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 WALNUT ST STE 300",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024812145",
"telephone_number": "617-286-5002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 WALNUT ST STE 300",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024812145",
"telephone_number": "176-286-5642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JILLIAN",
"middle_name": "BURLEY",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-19",
"last_updated": "2024-03-28",
"certification_date": "2024-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "10185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellesley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.