Individual provider Active NPI

Vicki Leigh Kellam, LICSW

  • Social Worker
  • Waltham, MA
National Provider Identifier
1972686202
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
281 Winter St Ste 340
Waltham, MA 02451-8766
Phone
(617) 999-2184
NPI assigned
Oct 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 115264 MA
Social Worker 104100000X Primary

Addresses

Primary practice location

281 Winter St Ste 340
Waltham, MA 02451-8766

Mailing address

281 Winter St Ste 340
Waltham, MA 02451-8766
Phone (781) 317-6009

Other identifiers 8

IdentifierTypeStateIssuer
1303287OtherMAMBHP
042611055OtherTAX ID
1303287MedicaidMA
703136OtherTUFTS
1004745OtherMANHP
996OtherNETWORK HEALTH
M18633OtherBCBS
NP01332OtherBOSTON MED

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170913001039 MA Practitioner - Clinical Social Worker 5698048619 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Child and Family Psychological Services PLLCGroup PAC ID 5991763823, 260 clinicians

Practice addresses (Care Compare)

281 Winter St
Suite 340
Waltham, MA 02451-8760
Phone (781) 646-0500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Edinburg Center Inc Clinical CurrentSince Jul 8, 2017 Accepting new patients
Child and Family Psychological Services, PLLC Clinical CurrentSince Nov 23, 2024 Accepting new patients

Locations

205 Burlington Rd
Bedford, MA 01730
Phone (781) 761-5064

89 Access Rd
Ste 24
Norwood, MA 02062
Phone (781) 336-5040

281 Winter St
Ste 340
Waltham, MA 02451
Phone (508) 996-3154

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1972686202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 WINTER ST STE 340",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024518766",
            "telephone_number": "781-317-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 WINTER ST STE 340",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024518766",
            "telephone_number": "617-999-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLAM",
        "first_name": "VICKI",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "115264",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MBHP",
            "identifier": "1303287",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "042611055",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303287",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "703136",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHP",
            "identifier": "1004745",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "996",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M18633",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOSTON MED",
            "identifier": "NP01332",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.