Provider Demographics
NPI:1770715732
Name:SCHIAVONE, KELLY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:SCHIAVONE
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 1:13 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-3183
Mailing Address - Country:US
Mailing Address - Phone:215-279-0983
Mailing Address - Fax:
Practice Address - Street 1:602 S BETHLEHEM PIKE STE B
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5809
Practice Address - Country:US
Practice Address - Phone:215-279-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058453001041C0700X
PACW0160811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical