Provider Demographics
NPI:1841763133
Name:CARDOSO, KELLEY J (MSW)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:J
Last Name:CARDOSO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 BLOOMING GROVE TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8003
Mailing Address - Country:US
Mailing Address - Phone:845-522-8346
Mailing Address - Fax:
Practice Address - Street 1:623 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8003
Practice Address - Country:US
Practice Address - Phone:845-522-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker