Provider Demographics
NPI:1043706195
Name:VIOLON, KELLIE ANN (LSW)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:VIOLON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-8912
Mailing Address - Country:US
Mailing Address - Phone:610-568-0348
Mailing Address - Fax:
Practice Address - Street 1:144 N 6TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3502
Practice Address - Country:US
Practice Address - Phone:610-375-7454
Practice Address - Fax:610-375-8521
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty