Provider Demographics
NPI:1346514700
Name:KELLY, CHRISTINE RACHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RACHAEL
Last Name:KELLY
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 1:117 STARBOARD VILLA APT 213
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5882
Mailing Address - Country:US
Mailing Address - Phone:412-610-2221
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHGATE SQ STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1395
Practice Address - Country:US
Practice Address - Phone:412-610-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0233151041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health