Provider Demographics
NPI:1710744800
Name:KELLY DUMAS, LCSW, PLLC
Entity Type:Organization
Organization Name:KELLY DUMAS, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-907-3344
Mailing Address - Street 1:251 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-3912
Mailing Address - Country:US
Mailing Address - Phone:716-907-3344
Mailing Address - Fax:
Practice Address - Street 1:251 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3912
Practice Address - Country:US
Practice Address - Phone:716-907-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty