Provider Demographics
NPI:1467505826
Name:PALLAS, KELLY MURRAY (MSW, LISW-S)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MURRAY
Last Name:PALLAS
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1951
Mailing Address - Country:US
Mailing Address - Phone:216-694-7016
Mailing Address - Fax:216-741-2632
Practice Address - Street 1:3518 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1951
Practice Address - Country:US
Practice Address - Phone:216-694-7016
Practice Address - Fax:216-741-2632
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00096661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical