Provider Demographics
NPI:1922860428
Name:URENA, KELLY J (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:URENA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:URENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:51 MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3123
Mailing Address - Country:US
Mailing Address - Phone:917-365-0699
Mailing Address - Fax:
Practice Address - Street 1:792 MOUNT AVE
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-4430
Practice Address - Country:US
Practice Address - Phone:917-365-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099685-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker