Provider Demographics
NPI:1477634160
Name:KELLY, ELIZABETH MARIA (MSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4531
Mailing Address - Country:US
Mailing Address - Phone:814-838-8385
Mailing Address - Fax:
Practice Address - Street 1:135 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1559
Practice Address - Country:US
Practice Address - Phone:814-868-8661
Practice Address - Fax:814-860-2335
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW002008E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker