Provider Demographics
NPI:1992848311
Name:KELLY, DOROTHY JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JANE
Last Name:KELLY
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 1:49 STEVEN PL
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5419
Mailing Address - Country:US
Mailing Address - Phone:631-366-2080
Mailing Address - Fax:
Practice Address - Street 1:49 STEVEN PL
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5419
Practice Address - Country:US
Practice Address - Phone:631-366-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071596-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical