Provider Demographics
NPI:1740469477
Name:SUTTON, KELLY L (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:LOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:254 FRANKLIN ST
Mailing Address - Street 2:LAKE SHORE BEHAVIORAL HEALTH
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1954
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:716-842-4069
Practice Address - Street 1:3176 ABBOTT RD BLDG A
Practice Address - Street 2:ABBOTT CORNERS
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1069
Practice Address - Country:US
Practice Address - Phone:716-822-2117
Practice Address - Fax:716-822-8165
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker