Provider Demographics
NPI:1275909137
Name:KELLEY, ERIN N
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:N
Last Name:KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3216
Mailing Address - Country:US
Mailing Address - Phone:513-887-8500
Mailing Address - Fax:513-737-8196
Practice Address - Street 1:820 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3216
Practice Address - Country:US
Practice Address - Phone:513-887-8500
Practice Address - Fax:513-737-8196
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
OHI.2203618104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator