Provider Demographics
NPI:1356632756
Name:WHITMAN, KELLY DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DENISE
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DENISE
Other - Last Name:WHITMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:951 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2116
Mailing Address - Country:US
Mailing Address - Phone:716-884-0700
Mailing Address - Fax:716-884-0631
Practice Address - Street 1:951 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2116
Practice Address - Country:US
Practice Address - Phone:716-884-0700
Practice Address - Fax:716-884-0631
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0825831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical