Provider Demographics
NPI:1457580631
Name:KELLEY, ELIZABETH MARIE (LSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TEE CIR
Mailing Address - Street 2:FLYING HILLS VILLAGE
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-3346
Mailing Address - Country:US
Mailing Address - Phone:610-796-0328
Mailing Address - Fax:
Practice Address - Street 1:1 MENNONITE CHURCH RD
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-1518
Practice Address - Country:US
Practice Address - Phone:610-948-6490
Practice Address - Fax:610-474-0011
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW00958OL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker