Provider Demographics
NPI:1235400219
Name:COLLINS-COLOSI, KELLY L (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:COLLINS-COLOSI
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 1:10 COLE DR
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1023
Mailing Address - Country:US
Mailing Address - Phone:607-334-1600
Mailing Address - Fax:
Practice Address - Street 1:89 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1948
Practice Address - Country:US
Practice Address - Phone:607-334-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068619-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker