Healthcare Provider Details

I. General information

NPI: 1023983525
Provider Name (Legal Business Name): INGRID M KELLY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 OPELOUSAS AVE # 17
NEW ORLEANS LA
70114-4343
US

IV. Provider business mailing address

2125 SOUTHWOOD CV SW UNIT 521
ATLANTA GA
30331-5891
US

V. Phone/Fax

Practice location:
  • Phone: 504-688-9323
  • Fax: 608-740-5963
Mailing address:
  • Phone: 504-858-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number15088
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number15088
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number15088
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number15088
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number15088
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number15088
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number15088
License Number StateLA
# 8
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15088
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: