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General NPI Number Information
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NPI Number | 1053023770
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Entity Type | Individual
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Provider Name | JONATHAN ROBERT KELLY LMSW
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Gender | Male
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 5505 NESCONSET HWY STE 222
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City | MOUNT SINAI
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State | NY
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Zip | 11766-2026
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Country | US
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Telephone | 631-892-2482
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Fax |
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Provider Business Mailing Address
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Address Line | 611 W 171ST ST APT 22A
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City | NEW YORK
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State | NY
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Zip | 10032-1948
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Country | US
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Telephone | 631-816-4068
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117202-01
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License Number State | NY
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