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General NPI Number Information
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NPI Number | 1124632294
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS KELLY LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 35 DOCK ST
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City | YONKERS
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State | NY
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Zip | 10701-2733
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Country | US
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Telephone | 914-965-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GRANDVIEW AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-3116
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Country | US
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Telephone | 914-960-8735
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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 | 110176
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License Number State | NY
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