Provider Demographics
NPI:1821383803
Name:DAVIS, KELLEY F (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:F
Last Name:DAVIS
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 1:195 DEPEW ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2903
Mailing Address - Country:US
Mailing Address - Phone:585-256-0765
Mailing Address - Fax:
Practice Address - Street 1:4115 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-4813
Practice Address - Country:US
Practice Address - Phone:585-663-7070
Practice Address - Fax:585-621-0275
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07770511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical