Provider Demographics
NPI:1336639038
Name:DUNN, KELLIE LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LEE
Last Name:DUNN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LEE
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2129 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3666
Mailing Address - Country:US
Mailing Address - Phone:315-527-2548
Mailing Address - Fax:
Practice Address - Street 1:2129 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3666
Practice Address - Country:US
Practice Address - Phone:315-527-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098926-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker