Provider Demographics
NPI:1477578714
Name:KELLEY, MEGHAN R (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:R
Last Name:KELLEY
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 1:25 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7253
Mailing Address - Country:US
Mailing Address - Phone:917-378-0676
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W
Practice Address - Street 2:SUITE 1U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7253
Practice Address - Country:US
Practice Address - Phone:917-378-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0613291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical