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KELLY ANN WALLER LMHC
NPI 1972269652
Counselor - Mental Health in Massapequa, NY

Active since November 16, 2021
54 CHICAGO AVE, MASSAPEQUA, NY 11758(516) 804-0448 Get Directions Write a Review

NPPES record last updated: November 16, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kelly Ann Waller Lmhc NPPES

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

KELLY ANN WALLER LMHC (NPI 1972269652) is an individual mental health provider in Massapequa, New York, licensed in New York (011709) and active in the NPI registry since November 2021. She maintains a secondary practice location in Amityville.

NPPES Registry Identity

NPI1972269652
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKELLY ANN WALLERCredential: LMHC
Location Address54 CHICAGO AVEMassapequa, NY 11758-4422
Mailing Address304 N Utica AveMassapequa, NY 11758-2148 · (516) 477-3203
Phone(516) 804-0448
Sole ProprietorYes
Enumeration DateNovember 16, 2021
NPPES CertifiedNovember 16, 2021
✔ NPI 1972269652 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in NY · 011709
54 CHICAGO AVE, Massapequa, NY 11758
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Secondary Practice Location 1

Location 1400 Sunrise HwyAmityville, NY 11701-2508 · Phone (631) 264-4000

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETH BEINER LCSW
Social Worker (Clinical)
54 CHICAGO AVE
MASSAPEQUA, NY 11758
Nassau County (516) 998-8350
ROSA M CARINO
Counselor
54 CHICAGO AVE
MASSAPEQUA, NY 11758
Nassau County (516) 528-6712
PENNY E SIEGMANN-BEINER LCSW-R
Social Worker (Clinical)
54 CHICAGO AVE
MASSAPEQUA, NY 11758
Nassau County (516) 528-6712
COUNSELING SERVICES OF LONG ISLAND LCSW PC
Clinic/Center (Mental Health (Including Community Mental Health Center))
54 CHICAGO AVE
MASSAPEQUA, NY 11758
Nassau County (516) 528-6712

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 Waller's NPI number?

The NPI number for Kelly Waller is 1972269652. It was assigned to this individual provider in the NPPES registry on November 16, 2021.

Where is Kelly Waller located?

Kelly Waller practices at 54 Chicago Ave, Massapequa, NY 11758. The listed phone number is (516) 804-0448.

What is Kelly Waller's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Kelly Waller was last updated on November 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.