Healthcare Provider Details

I. General information

NPI: 1740802784
Provider Name (Legal Business Name): KELLY BARTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 NAAMANS RD
CLAYMONT DE
19703-2308
US

IV. Provider business mailing address

1114 S DUPONT HWY STE 105
DOVER DE
19901-4401
US

V. Phone/Fax

Practice location:
  • Phone: 302-442-6194
  • Fax: 302-442-6940
Mailing address:
  • Phone: 302-442-6194
  • Fax: 302-442-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001794
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: