Doctor Name: | KELLY G DICENSO |
NPI Number: | 1053622829 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LSCW |
License Number: | 34005990A |
Business Practice Address: | 2901 Ohio Blvd Suite 202 Terre Haute, IN - 478032239 |
Business Phone Number: | 8122322144 |
Business Fax Number: | 8122344598 |
Mailing Address: | 2901 Ohio Blvd, Suite 202 TERRE HAUTE |
State: | IN |
Postal Code: | 478032239 |
Phone Number: | 8122322144 |
Fax Number: | 8122344598 |
NPI Enumeration Date: | 06/28/2010 |
NPI Last Update Date: | 06/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 34005990A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |