Provider Demographics
NPI:1417328634
Name:MACHADO, KELLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:MACHADO
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 1:151 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3346
Mailing Address - Country:US
Mailing Address - Phone:203-828-0704
Mailing Address - Fax:866-649-9074
Practice Address - Street 1:100 BANK ST STE 104
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2806
Practice Address - Country:US
Practice Address - Phone:203-828-0704
Practice Address - Fax:866-649-9074
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical