Healthcare Provider Details

I. General information

NPI: 1750147807
Provider Name (Legal Business Name): MEGHAN BARBARA KELLY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOLLOW LN STE 301
NEW HYDE PARK NY
11042-1215
US

IV. Provider business mailing address

1 HOLLOW LN STE 301
NEW HYDE PARK NY
11042-1215
US

V. Phone/Fax

Practice location:
  • Phone: 631-553-2162
  • Fax:
Mailing address:
  • Phone: 631-553-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07427000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123290
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: