Doctor Name: | CARYN KELLEY |
NPI Number: | 1154763589 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149.003207 |
Business Practice Address: | 607 7th St Wilmette, IL - 600911919 |
Business Phone Number: | 8472510332 |
Business Fax Number: | 8472510332 |
Mailing Address: | 607 7th St, WILMETTE |
State: | IL |
Postal Code: | 600911919 |
Phone Number: | 8472510332 |
Fax Number: | 8472510332 |
NPI Enumeration Date: | 07/26/2013 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.003207 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |