Provider Demographics
NPI:1841594645
Name:KELLY, AMY BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:SCHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:85 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-5517
Mailing Address - Country:US
Mailing Address - Phone:315-406-1981
Mailing Address - Fax:315-702-8300
Practice Address - Street 1:2 EASTERLY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3778
Practice Address - Country:US
Practice Address - Phone:315-679-4727
Practice Address - Fax:315-702-8300
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078322104100000X
NY0820771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker