Provider Demographics
NPI:1740791920
Name:KELLY, CATHERINE LOUISE (LSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LOUISE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5160 CARLISLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350-9797
Mailing Address - Country:US
Mailing Address - Phone:717-309-2525
Mailing Address - Fax:
Practice Address - Street 1:8130 ADAMS DR
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8623
Practice Address - Country:US
Practice Address - Phone:717-967-8288
Practice Address - Fax:717-967-8291
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA126577104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker