Provider Demographics
NPI:1467626192
Name:GULLING-DEJOE, KELLY CHRISTIN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:CHRISTIN
Last Name:GULLING-DEJOE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LOCKWOOD DRIVE #210
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-586-0240
Mailing Address - Fax:585-586-0261
Practice Address - Street 1:1 LOCKWOOD DRIVE #210
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-586-0240
Practice Address - Fax:585-586-0261
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0737551041C0700X
NYR07375511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical