Provider Demographics
NPI:1497209167
Name:MEANY, KELLY (LMSW, LADC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MEANY
Suffix:
Gender:F
Credentials:LMSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OLD KINGS HWY RD
Mailing Address - Street 2:
Mailing Address - City:DANEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820
Mailing Address - Country:US
Mailing Address - Phone:203-984-1994
Mailing Address - Fax:703-202-2209
Practice Address - Street 1:30 OLD KINGS HWY RD
Practice Address - Street 2:
Practice Address - City:DANEN
Practice Address - State:CT
Practice Address - Zip Code:06820
Practice Address - Country:US
Practice Address - Phone:203-984-1994
Practice Address - Fax:703-202-2209
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1330101YA0400X
NY098303171M00000X
CT114951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator