Provider Demographics
NPI:1609141126
Name:EARL, KELLY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:EARL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-5137
Mailing Address - Country:US
Mailing Address - Phone:610-585-4470
Mailing Address - Fax:
Practice Address - Street 1:723 WHEATLAND ST STE 1A
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-5361
Practice Address - Country:US
Practice Address - Phone:610-415-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical