Provider Demographics
NPI:1568616936
Name:VOCCOLA, KELLY A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:VOCCOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:DANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:350 S MAIN ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3160
Mailing Address - Country:US
Mailing Address - Phone:203-271-1234
Mailing Address - Fax:203-272-9094
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:SUITE 23
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3160
Practice Address - Country:US
Practice Address - Phone:203-271-1234
Practice Address - Fax:203-272-9094
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical