Healthcare Provider Details

I. General information

NPI: 1871885426
Provider Name (Legal Business Name): LYNN ELAINE KELLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVENUE VA CENTRAL CALIFORNIA HEALTH CARE SYSTEM
FRESNO CA
93703-2223
US

IV. Provider business mailing address

2615 E CLINTON AVENUE VA CENTRAL CALIFORNIA HEALTH CARE SYSTEM
FRESNO CA
93703-2223
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax: 559-241-6482
Mailing address:
  • Phone: 559-225-6100
  • Fax: 559-241-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: