Provider Demographics
NPI:1932569373
Name:PIERCE, KELSEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PIERCE
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 1:1433 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5310
Mailing Address - Country:US
Mailing Address - Phone:727-480-3148
Mailing Address - Fax:727-772-5569
Practice Address - Street 1:2706 ALT 19
Practice Address - Street 2:221
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2662
Practice Address - Country:US
Practice Address - Phone:727-432-4221
Practice Address - Fax:727-772-5569
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-27
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW134951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical