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MRS. KELLY HANNON NICHOLS LCSW-R
NPI 1649640764
Social Worker - Clinical in Fayetteville, NY

Active since October 01, 2015PECOS Enrolled
215 DAWLEY RD, FAYETTEVILLE, NY 13066(315) 420-6293(315) 637-7576 Get Directions Write a Review

NPPES record last updated: October 1, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mrs. Kelly Hannon Nichols Lcsw-r NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KELLY HANNON NICHOLS LCSW-R (NPI 1649640764) is an individual clinical provider in Fayetteville, New York, licensed in New York (73070425) and active in the NPI registry since October 2015. She is enrolled in Medicare PECOS and is a graduate of Other (2001).

NPPES Registry Identity

NPI1649640764
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameMRS. KELLY HANNON NICHOLSCredential: LCSW-R
Location Address215 DAWLEY RDFayetteville, NY 13066-2546
Mailing Address215 Dawley RdFayetteville, NY 13066-2546 · (315) 420-6293 · Fax (315) 637-7576
Phone(315) 420-6293
Fax(315) 637-7576
Sole ProprietorYes
Medical School CMSOtherGraduated 2001
Enumeration DateOctober 1, 2015
✔ NPI 1649640764 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in NY · 73070425
Definition
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.
215 DAWLEY RD, Fayetteville, NY 13066
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Other Names 1

Professional Name (2)Kelly Hannon Lcsw-r

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Kelly Hannon Nichols Lcsw-r is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8426339482
PECOS Enrollment IDI20170105001080
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13066 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $54.87 – $166.88
Typical copayment $0.00 (range $13.71 – $41.72)
Most-billed visit code NA
Established Patient
$68.57 typical visit price
range $17.54 – $136.14
Typical copayment $17.14 (range $4.38 – $34.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Nichols's NPI number?

The NPI number for Kelly Nichols is 1649640764. It was assigned to this individual provider in the NPPES registry on October 1, 2015. The provider is also known as Kelly Hannon Lcsw-R.

Where is Kelly Nichols located?

Kelly Nichols practices at 215 Dawley Rd, Fayetteville, NY 13066. The listed phone number is (315) 420-6293.

What is Kelly Nichols's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kelly Nichols enrolled in Medicare?

Yes. Kelly Nichols is registered in the Medicare PECOS enrollment system.

What insurance does Kelly Nichols accept?

Health plans from Providence Health Plan list Kelly Nichols as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Nichols was last updated on October 1, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.