MEDICARE: KELLY M STARKEY LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	S.0031008	OH

General Provider Information

NPI Number	:	1619114113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M STARKEY LSW

Provider Business Mailing Address
First Line	:	2600 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1711
Country	:	US
Telephone Number	:	513-751-7747
Fax Number	:	513-872-5182

Provider Business Practice Location Address
First Line	:	4968 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3902
Country	:	US
Telephone Number	:	513-557-2810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	03/13/2009

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