Provider Demographics
NPI:1982085023
Name:POWELL, KELLY (LSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 N FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5891
Mailing Address - Country:US
Mailing Address - Phone:724-222-5433
Mailing Address - Fax:724-228-7619
Practice Address - Street 1:2114 N FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5891
Practice Address - Country:US
Practice Address - Phone:724-222-5433
Practice Address - Fax:724-228-7619
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126991104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker