Provider Demographics
NPI:1801931241
Name:KELLY, LINDA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:KELLY
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 1:2220 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611
Mailing Address - Country:US
Mailing Address - Phone:510-530-9553
Mailing Address - Fax:510-530-6231
Practice Address - Street 1:2220 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611
Practice Address - Country:US
Practice Address - Phone:510-530-9553
Practice Address - Fax:510-530-6231
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCS104431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical