Provider Demographics
NPI:1033325683
Name:KELLY, SHARON ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7344 E SOARING EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1280
Mailing Address - Country:US
Mailing Address - Phone:480-575-7530
Mailing Address - Fax:480-575-7532
Practice Address - Street 1:3420 E SHEA BLVD STE 215
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3345
Practice Address - Country:US
Practice Address - Phone:480-390-9678
Practice Address - Fax:480-575-7532
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-34011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ73392Medicare PIN