Healthcare Provider Details

I. General information

NPI: 1700708005
Provider Name (Legal Business Name): KELLEY ANNE BATES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HICKORY DR
COVENTRY CT
06238-2803
US

IV. Provider business mailing address

90 HICKORY DR
COVENTRY CT
06238-2803
US

V. Phone/Fax

Practice location:
  • Phone: 860-337-1774
  • Fax:
Mailing address:
  • Phone: 860-337-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17112
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: