Provider Demographics
NPI:1376078089
Name:BERTHOLD, KELLY CORINNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CORINNE
Last Name:BERTHOLD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E PARK STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6706
Mailing Address - Country:US
Mailing Address - Phone:814-235-2480
Mailing Address - Fax:814-235-2452
Practice Address - Street 1:315 S ALLEN ST STE 326
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-865-2191
Practice Address - Fax:148-638-1331
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical