Provider Demographics
NPI:1275244857
Name:PALUSO, KELLY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:PALUSO
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 1:1873 E RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3111
Mailing Address - Country:US
Mailing Address - Phone:801-946-7092
Mailing Address - Fax:
Practice Address - Street 1:1873 E RAMONA AVE
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-3111
Practice Address - Country:US
Practice Address - Phone:801-946-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10356366-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty