Provider Demographics
NPI:1750669339
Name:CONFORTI, KELLY M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:CONFORTI
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 1:281 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1101
Mailing Address - Country:US
Mailing Address - Phone:570-203-2330
Mailing Address - Fax:
Practice Address - Street 1:281 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1101
Practice Address - Country:US
Practice Address - Phone:570-952-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
NJ44SC060800001041C0700X
PACW0198441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker