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General NPI Number Information
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NPI Number | 1326573312
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Entity Type | Individual
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Provider Name | MICHELE KELLY LCSW/ LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 12 CASE ST STE 302
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City | NORWICH
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State | CT
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Zip | 06360-2222
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Country | US
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Telephone | 860-294-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 27 BITGOOD RD
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City | JEWETT CITY
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State | CT
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Zip | 06351-1503
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Country | US
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Telephone | 860-576-7834
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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 | ISW03641
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License Number State | RI
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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 | 9774
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License Number State | CT
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