Provider Demographics
NPI:1760035646
Name:MOONEY, KELSEY ANN (LMHC, CASAC)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:ANN
Last Name:MOONEY
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, CASAC
Mailing Address - Street 1:7254 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-3432
Mailing Address - Country:US
Mailing Address - Phone:315-404-4036
Mailing Address - Fax:
Practice Address - Street 1:7254 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-3432
Practice Address - Country:US
Practice Address - Phone:315-404-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31319101YA0400X
NY007463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)