Provider Demographics
NPI:1508224858
Name:TAYLOR, KELLY (LADC, LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COVEY RD
Mailing Address - Street 2:2AF
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1720
Mailing Address - Country:US
Mailing Address - Phone:860-259-4442
Mailing Address - Fax:
Practice Address - Street 1:9 COVEY RD
Practice Address - Street 2:2AF
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1720
Practice Address - Country:US
Practice Address - Phone:860-259-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1166101YA0400X
CT99151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008067986Medicaid