Provider Demographics
NPI:1720250293
Name:MARRON, KELLEY MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:MARIE
Last Name:MARRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:MARIE
Other - Last Name:GARBINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1765 GOUCHER ST
Mailing Address - Street 2:STE 150
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1101
Mailing Address - Country:US
Mailing Address - Phone:814-535-8586
Mailing Address - Fax:814-254-4170
Practice Address - Street 1:1765 GOUCHER ST
Practice Address - Street 2:STE 150
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1101
Practice Address - Country:US
Practice Address - Phone:814-535-8586
Practice Address - Fax:814-254-4170
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0166941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical