Provider Demographics
NPI:1033305099
Name:HODGESHARRELL, KELLEY RENAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:RENAE
Last Name:HODGESHARRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OPAL ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4305
Mailing Address - Country:US
Mailing Address - Phone:516-775-0951
Mailing Address - Fax:
Practice Address - Street 1:28 OPAL ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4305
Practice Address - Country:US
Practice Address - Phone:516-775-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0750511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical