Provider Demographics
NPI:1184781965
Name:KELLY, LINDA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 BROOKSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-2744
Mailing Address - Country:US
Mailing Address - Phone:914-423-4433
Mailing Address - Fax:914-423-9434
Practice Address - Street 1:190 GOLDENS BRIDGE COURT
Practice Address - Street 2:BEDFORD PROFESSIONAL BLDG.
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536
Practice Address - Country:US
Practice Address - Phone:914-423-4433
Practice Address - Fax:914-423-9434
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0701651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY250251OtherHEALTHNET
NYNX72410Medicare PIN