Kelly Bennett, LMSW
Individual provider Active NPI Social Worker · Shirley, NY
NPI 1992260558 · NPPES record last updated Aug 25, 2025
Key facts
- NPI
- 1992260558
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 122771 (NY)
- Practice address
- 2 Coraci Blvd Ste 15&16
Shirley, NY 11967-4833 - Phone
- (631) 696-4357
- NPI assigned
- Feb 7, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Counseling LCSW, PLLC | Past |
Accepting new patients | |
| CS Medical Associates, P.C. | Past |
Accepting new patients | |
| CS Medical Associates, P.C. | Past |
Accepting new patients |
Interoperability endpoints
- kbennett@victoryrecovery.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 122771 | NY | Yes |
Addresses
Primary practice location
2 Coraci Blvd Ste 15&16
Shirley, NY 11967-4833
Mailing address
1377 Motor Pkwy Ste 102
Islandia, NY 11749-5249
Other practice location 1
3635 Bell Blvd Ste 203
Bayside, NY 11361-2097
Phone (718) 504-9256
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03299096 | Medicaid | NY |
Other providers in Shirley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.