Provider Demographics
NPI:1255303830
Name:LAROSA, KELLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:LAROSA
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 1:5850 S 6TH STREET RD
Mailing Address - Street 2:A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5162
Mailing Address - Country:US
Mailing Address - Phone:217-529-5046
Mailing Address - Fax:217-529-6154
Practice Address - Street 1:5850 S 6TH STREET RD
Practice Address - Street 2:A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5162
Practice Address - Country:US
Practice Address - Phone:217-529-5046
Practice Address - Fax:217-529-6154
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490011321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical