Provider Demographics
NPI:1194858373
Name:GALEANO, KELLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:GALEANO
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 1:17505 N 79TH AVE STE 311E
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8730
Mailing Address - Country:US
Mailing Address - Phone:602-390-1135
Mailing Address - Fax:623-476-7976
Practice Address - Street 1:17505 N 79TH AVE STE 311E
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8730
Practice Address - Country:US
Practice Address - Phone:602-390-1135
Practice Address - Fax:623-476-7976
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-114541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical