Provider Demographics
NPI:1669290391
Name:HOLIDAY, KELLEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:KOCHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 STEPHAN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3030
Mailing Address - Country:US
Mailing Address - Phone:512-413-4742
Mailing Address - Fax:
Practice Address - Street 1:1 FAMILY PRACTICE DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6449
Practice Address - Country:US
Practice Address - Phone:512-413-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0972821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical