Provider Demographics
NPI:1073744090
Name:KELLY-ZION, SOPHRONIA DEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SOPHRONIA
Middle Name:DEE
Last Name:KELLY-ZION
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 1:118 ROUTT ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4662
Mailing Address - Country:US
Mailing Address - Phone:210-930-7841
Mailing Address - Fax:210-614-5633
Practice Address - Street 1:8310 EWING HALSELL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3715
Practice Address - Country:US
Practice Address - Phone:210-616-0885
Practice Address - Fax:210-614-5633
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0040EXOtherBLUE CROOS BLUE SHIELD
00827EMedicare PIN