Provider Demographics
NPI:1942516620
Name:KELLY-KELLER, PAULA A (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:KELLY-KELLER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 EL PASO ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1141
Mailing Address - Country:US
Mailing Address - Phone:412-361-5633
Mailing Address - Fax:
Practice Address - Street 1:4760 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1704
Practice Address - Country:US
Practice Address - Phone:412-687-8017
Practice Address - Fax:412-687-3315
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128016104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker