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General NPI Number Information
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NPI Number | 1194382127
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Entity Type | Organization
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Legal Business Name | KELLY KOLODZIEJSKI LCSW R
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 916 OLD LIVERPOOL RD STE B
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City | LIVERPOOL
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State | NY
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Zip | 13088-8536
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Country | US
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Telephone | 315-743-4042
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Fax |
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Provider Business Mailing Address
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Address Line | 318 EAGLES POINT CIR
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City | LIVERPOOL
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State | NY
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Zip | 13090-3332
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Country | US
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Telephone | 315-743-4042
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY K KOLODZIEJSKI
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Credential | LCSW R
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Telephone | 315-743-4042
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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 |
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License Number State |
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