Provider Demographics
NPI:1700654688
Name:KELIUOTIS, INDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:INDRA
Middle Name:
Last Name:KELIUOTIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FLAT SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1859
Mailing Address - Country:US
Mailing Address - Phone:203-907-6452
Mailing Address - Fax:
Practice Address - Street 1:54 FLAT SWAMP RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1859
Practice Address - Country:US
Practice Address - Phone:203-907-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT135321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical