MEDICARE: RENEE CIND KAY KELLY LMSW

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	104100000X	Social Worker	120452-01	NY

General Provider Information

NPI Number	:	1861177008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE CIND KAY KELLY LMSW

Provider Business Mailing Address
First Line	:	170 OLD COUNTRY RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2198
Country	:	US
Telephone Number	:	540-645-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 OLD COUNTRY RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2198
Country	:	US
Telephone Number	:	631-208-4460
Fax Number	:

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

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	12/01/2025

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