Doctor Name: | SUSAN KELLY |
NPI Number: | 1043386246 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | 111523 |
Business Practice Address: | 42 Wendell Avenue Pittsfield, MA - 01201 |
Business Phone Number: | 4132818984 |
Business Fax Number: | 4134969116 |
Mailing Address: | 509 Pecks Rd, PITTSFIELD |
State: | MA |
Postal Code: | 012011339 |
Phone Number: | 4132818984 |
Fax Number: | |
NPI Enumeration Date: | 11/28/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 111523 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |