Provider Demographics
NPI:1386000255
Name:LEAN, KELLY (LISW-S)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LEAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CINCINNATI BATAVIA PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1557
Mailing Address - Country:US
Mailing Address - Phone:513-752-1555
Mailing Address - Fax:513-753-2144
Practice Address - Street 1:555 CINCINNATI BATAVIA PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1557
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:513-753-2144
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0010195-S1041C0700X
OHOH13721601041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool