Provider Demographics
NPI:1033764311
Name:ULRICH, KELLY D (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:D
Last Name:ULRICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-8750
Mailing Address - Country:US
Mailing Address - Phone:845-706-1377
Mailing Address - Fax:
Practice Address - Street 1:1372 OLD POST RD
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5357
Practice Address - Country:US
Practice Address - Phone:845-255-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker