Provider Demographics
NPI:1467514745
Name:LENNON-MARTUCCI, KELLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:LENNON-MARTUCCI
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 1:6730 RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5246
Mailing Address - Country:US
Mailing Address - Phone:203-767-2567
Mailing Address - Fax:
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-1180
Practice Address - Fax:718-245-2517
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker