KELLY FANTY (NPI# 1528527033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528527033 |
| Entity Type | Individual |
| Full Name | KELLY FANTY |
| Practice Address |
355 Waverly Oaks Rd Ste 100 Waltham MA 02452-8480 |
| Mailing Address |
355 Waverley Oaks Rd Ste 100 Waltham MA 02452-8480 |
| Practice Telephone | 7813147600 |
| Mailing Telephone | 5087855786 |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2020-06-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
122000 | MA | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 355 Waverly Oaks Rd Ste 100, Waltham, MA 024528480 | 7813147600 |
| Street Address |
355 WAVERLY OAKS RD STE 100 |
| City | WALTHAM |
| State | MA |
| Zip Code | 02452-8480 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346894896 | Nsea Macipa LLC | Ophthalmology | 135 Beaver Street Ste 309, Waltham, MA 02452 | 2019-08-01 |
| 1750879383 | Rosemary Klein | Psychologist | Waltham Court Clinic, 38 Linden St., Waltham, MA 02452 | 2018-04-30 |
| 1497256374 | Chithra Susan Kuriakose | Nurse Practitioner | Waltham Medical Group, 6 Lexington St., 2nd Floor, Waltham, MA 02452 | 2018-02-26 |
| 1861883001 | Melanie H Deveikas | Physical Therapist | 425 Waverley Oaks Rd, Waltham, MA 02452 | 2015-02-10 |
| 1770992059 | Hope Elisabeth Forbes | Psychologist | 175 Forest St., Bentley University Counseling Center, Waltham, MA 02452 | 2014-08-12 |
| 1326462557 | Ann M Fletcher | Social Worker | 100 Church St., Waltham, MA 02452 | 2014-02-07 |
| 1801239397 | Rainbow Adhc of Waltham | Clinic/Center | 411 Waverly Oak Rd # 2, Suite 214, Waltham, MA 02452 | 2013-04-15 |
| 1356689335 | Jessica M Liberty | Physical Therapist | 425 Waverley Oaks Rd., Waltham, MA 02452 | 2013-01-25 |
| 1386946960 | Janyce M Gately | Dietitian, Registered | 425 Waverley Oaks Rd Ste 200, Waltham, MA 02452 | 2010-12-02 |
| 1265618839 | Anita Lynn Hurd | Registered Nurse | 411 Waverely Oaks Road, Building #3, Suite 305, Waltham, MA 02452 | 2008-01-14 |
| Find all providers in zip 02452 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760082945 | Natalie Pierpont Waggaman | Social Worker | 34 Hamilton Rd, Waltham, MA 02453-1516 | 2020-10-28 |
| 1578035721 | Sarah Elizabeth Teeven | Social Worker | 17 Linden Park Dr, Waltham, MA 02452-6216 | 2018-12-28 |
| 1588132682 | Lee Ann Walker Lowe | Social Worker | 99 Bright St # 2, Waltham, MA 02453-6580 | 2018-11-06 |
| 1679040935 | Elsa L. Lichman | Social Worker | 52 Derby Street, Waltham, MA 02453 | 2018-10-25 |
| 1699240606 | Ronda Marie Randazzo | Social Worker | 309 Waverly Oaks Rd, Waltham, MA 02452-8443 | 2018-10-05 |
| 1518442870 | Jody O Gastfriend | Social Worker | 77 4th Ave, Waltham, MA 02451-7559 | 2018-10-02 |
| 1356826614 | Jill Mcnamara | Social Worker | 77 4th Ave Ste 500, Waltham, MA 02451-7559 | 2018-10-02 |
| 1124503792 | Janet Louise Mason | Social Worker | 88 Fuller St, Waltham, MA 02453-5841 | 2018-09-30 |
| 1245715879 | Annie F Friedman | Social Worker | Extended Stay America, 32 4the Avenue, Waltham, MA 02451 | 2018-09-28 |
| 1215412010 | Linda Ayer | Social Worker | 135 Beaver St Unit 111, Waltham, MA 02452-8412 | 2018-09-27 |
| Find all providers in WALTHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.