Provider Demographics
NPI:1548223613
Name:REDMON, KELLY (MSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:REDMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SUNNY ISLE SUITE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4500
Mailing Address - Country:US
Mailing Address - Phone:340-719-0685
Mailing Address - Fax:340-719-0685
Practice Address - Street 1:4500 SUNNY ISLE SUITE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4500
Practice Address - Country:US
Practice Address - Phone:340-719-0685
Practice Address - Fax:340-719-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor