Kellie Dahlstrom, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

118781 Issued in MA

Practice address

50 Elm St
#3B
Worcester, MA 01609-2574

Phone

(508) 755-0436

NPI assigned

Jan 22, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1453420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650240000000",
    "number": "1972960888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MCINTYRE RD",
            "city": "CHARLTON",
            "state": "MA",
            "postal_code": "015075125",
            "telephone_number": "774-200-6371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ELM ST",
            "address_2": "#3B",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092574",
            "telephone_number": "508-755-0436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 Stratton Rd",
            "address_purpose": "LOCATION",
            "city": "Rutland",
            "state": "VT",
            "postal_code": "057014621",
            "country_code": "US",
            "telephone_number": "802-773-3386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAHLSTROM",
        "first_name": "KELLIE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-22",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "118781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delia Dagli, PA
• Lisa Dagnello, B.S.
• Rebecca Lynn Dagostino, LICSW
• Mihaela Eugenia Cernenco Dahl
• Seth T Dahlberg, M.D.
• Ruth I Dahlstrom, C.R.N.A.
• Idris Z Dahod, M.D.
• Amanda Marie Dahrooge, NP
• Yancheng Dai, MD
• Amanda Daigle

• Clinical Social Worker in Worcester, MA
• Providers in Worcester, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.