Healthcare Provider Details

I. General information

NPI: 1831599695
Provider Name (Legal Business Name): AMY M KELCH LSW, BSL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COMMERCE PARK DR SUITE 110
WILLIAMSPORT PA
17701-5475
US

IV. Provider business mailing address

320 HIGHLAND DR P.O. BOX 597
MOUNTVILLE PA
17554-1232
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-6944
  • Fax: 570-323-1812
Mailing address:
  • Phone: 717-285-7121
  • Fax: 717-285-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002264
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137320
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: