Provider Demographics
NPI:1619595022
Name:MEYER, KELLY J (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MEYER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ROCKVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5535
Mailing Address - Country:US
Mailing Address - Phone:516-204-2324
Mailing Address - Fax:
Practice Address - Street 1:46 ROCKVILLE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5535
Practice Address - Country:US
Practice Address - Phone:516-204-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-12
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker