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General NPI Number Information
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NPI Number | 1033764311
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Entity Type | Individual
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Provider Name | KELLY D ULRICH LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 1372 OLD POST RD
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City | ULSTER PARK
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State | NY
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Zip | 12487-5357
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Country | US
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Telephone | 845-255-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 555 MAIN ST
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City | KINGSTON
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State | NY
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Zip | 12401-8750
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Country | US
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Telephone | 845-706-1377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 106293
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License Number State | NY
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