Provider Demographics
NPI:1013928423
Name:KELLY, ROBERT J (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
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 1:11825 ROCK LANDING DR
Mailing Address - Street 2:100 JAMES BLDG.
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4236
Mailing Address - Country:US
Mailing Address - Phone:757-873-1736
Mailing Address - Fax:
Practice Address - Street 1:11825 ROCK LANDING DR
Practice Address - Street 2:100 JAMES BLDG.
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4236
Practice Address - Country:US
Practice Address - Phone:757-873-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040003611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical