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General NPI Number Information
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NPI Number | 1063913721
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Entity Type | Individual
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Provider Name | KELSEY JANE MORELL MASSIE LICSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 2355 MN-36 #200
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City | ST. PAUL
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State | MN
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Zip | 55113
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Country | US
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Telephone | 914-393-3578
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | LONG LAKE
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State | MN
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Zip | 55356-0014
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Country | US
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Telephone | 914-393-3578
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 940710
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27173
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 098372
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0009921466
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License Number State | CO
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