Provider Demographics
NPI:1861680258
Name:SCOTT, KELLY JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:SCOTT
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 1:2129 SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4326
Mailing Address - Country:US
Mailing Address - Phone:510-384-2063
Mailing Address - Fax:
Practice Address - Street 1:1516 OAK ST
Practice Address - Street 2:STE 310
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2958
Practice Address - Country:US
Practice Address - Phone:510-384-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 203611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical