Active NPI
Kenny Tello
- Clinical Social Worker
- Longwood, FL
National Provider Identifier
1972931988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW11027
- Practice address
- 455 W Warren Ave
Longwood, FL 32750-4038 - Phone
- (407) 262-2220
- Fax
- (407) 834-5011
- NPI assigned
- Oct 30, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 | SW11027 | FL | Primary |
Addresses
Primary practice location
455 W Warren Ave
Longwood, FL 32750-4038
Mailing address
455 W Warren Ave
Longwood, FL 32750-4038
Phone (407) 262-2220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106779400 | Medicaid | FL |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW11027 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1972931988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 W WARREN AVE",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504038",
"telephone_number": "407-262-2220",
"fax_number": "407-834-5011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 W WARREN AVE",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504038",
"telephone_number": "407-262-2220",
"fax_number": "407-834-5011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TELLO",
"first_name": "KENNY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-30",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW11027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106779400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.