Provider Demographics
NPI:1952848525
Name:KELLY, KEVIN (MSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 DELAFIELD RD RM 1A105
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1802
Mailing Address - Country:US
Mailing Address - Phone:412-822-3897
Mailing Address - Fax:412-822-1289
Practice Address - Street 1:1010 DELAFIELD RD RM 1A105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-1802
Practice Address - Country:US
Practice Address - Phone:412-822-3897
Practice Address - Fax:412-822-1289
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133726104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker