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General NPI Number Information
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NPI Number | 1194119941
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Entity Type | Individual
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Provider Name | KELLY FALLON MSW, LISW-S, LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 4220 HOUSTON RD
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City | ERLANGER
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State | KY
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Zip | 41018-3402
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Country | US
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Telephone | 502-262-2887
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Fax |
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Provider Business Mailing Address
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Address Line | 8665 TUDOR CT
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City | CINCINNATI
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State | OH
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Zip | 45242-7836
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Country | US
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Telephone | 513-771-7239
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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 | 254010
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1201146-SUPV
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 254010
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License Number State | KY
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