Provider Demographics
NPI:1669531828
Name:GROVER, KELLEY JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:JEAN
Last Name:GROVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:JEAN
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:223 S LIVERMORE RD
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:ME
Mailing Address - Zip Code:04282-3102
Mailing Address - Country:US
Mailing Address - Phone:207-577-1646
Mailing Address - Fax:
Practice Address - Street 1:540 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:ME
Practice Address - Zip Code:04434-3818
Practice Address - Country:US
Practice Address - Phone:207-577-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC115501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical