Provider Demographics
NPI:1518985605
Name:MAFFIA, KELLY E (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:MAFFIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:E
Other - Last Name:STATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7001 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-8257
Mailing Address - Country:US
Mailing Address - Phone:814-599-6186
Mailing Address - Fax:
Practice Address - Street 1:4133 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BROAD TOP
Practice Address - State:PA
Practice Address - Zip Code:16621-9001
Practice Address - Country:US
Practice Address - Phone:814-635-2916
Practice Address - Fax:814-635-2918
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022409020001Medicaid
PA102240902-0002Medicaid
PA1667176OtherHIGHMARK BC/BS