1497025159 NPI number — MS. KELLY MCKENNEY GOLDEN LMHC

Table of content: DR. AMANDA L SHOEMAKER MD (NPI 1235354804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497025159 NPI number — MS. KELLY MCKENNEY GOLDEN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDEN
Provider First Name:
KELLY
Provider Middle Name:
MCKENNEY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCKENNEY
Provider Other First Name:
KELLY
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497025159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 LOCUST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02871-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-297-9994
Provider Business Mailing Address Fax Number:
401-521-4242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 LOCUST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02871-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-297-9994
Provider Business Practice Location Address Fax Number:
401-521-4242
Provider Enumeration Date:
01/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MHC00631 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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