Kelley M Sullivan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

50388 Issued in TX

Practice address

166 High Point Dr
Longmont, CO 80504-8540

Phone

(512) 905-0072

NPI assigned

Mar 22, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Shine Medical Providers PC

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1538894050
  NPD (past)

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1962528778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 HIGH POINT DR",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805048540",
            "telephone_number": "512-905-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 HIGH POINT DR",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805048540",
            "telephone_number": "512-905-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLEY",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "50388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC. CLINICAL SOCIAL WORK",
            "identifier": "50388",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Conrad Stutznegger, DDS
• Gregory Lynn Styles, LCSW
• Susan Stype, OTR
• Priya Subramanian, DPT
• Rebecca Suckow, PT, DPT
• Paul Richard Sullivan
• Scott Patric Sullivan, M.H.A.,A.T.C, R.K.T.
• Summey Chiropractic P.C.
• Summit Neuromonitoring LLC
• Summit Wellness Group Inc

• Clinical Social Worker in Longmont, CO
• Providers in Longmont, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.