Healthcare Provider Details

I. General information

NPI: 1073051637
Provider Name (Legal Business Name): KELLY SNEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY SNEE DALLY

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6332 US HIGHWAY 301 S
RIVERVIEW FL
33578-3829
US

IV. Provider business mailing address

6332 US HIGHWAY 301 S
RIVERVIEW FL
33578-3829
US

V. Phone/Fax

Practice location:
  • Phone: 813-789-3356
  • Fax:
Mailing address:
  • Phone: 813-789-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW11180
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: