| Doctor Name: | MS. KELLY D PROTHERO |
| NPI Number: | 1225112055 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCS 26369 |
| Business Practice Address: | 100 Tamal Plz Suite 195 Corte Madera, CA - 949251125 |
| Business Phone Number: | 4154978322 |
| Business Fax Number: | |
| Mailing Address: | 321 Laurel Pl, SAN RAFAEL |
| State: | CA |
| Postal Code: | 949012012 |
| Phone Number: | 4157478903 |
| Fax Number: | |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 05/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS 26369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |