Provider Demographics
NPI:1316211832
Name:KELLY, ARLEEN GRACE (LSW)
Entity Type:Individual
Prefix:
First Name:ARLEEN
Middle Name:GRACE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 OHIO RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-1454
Mailing Address - Country:US
Mailing Address - Phone:412-766-4030
Mailing Address - Fax:412-766-5434
Practice Address - Street 1:8235 OHIO RIVER BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-1454
Practice Address - Country:US
Practice Address - Phone:412-766-4030
Practice Address - Fax:412-766-5434
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-010473-L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW-010473-LOtherSOCIAL WORK LICENSE