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General NPI Number Information
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NPI Number | 1366913485
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Entity Type | Individual
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Provider Name | DWIGHT KELLY MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 215 N MAIN ST
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05009-1082
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Country | US
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Telephone | 802-295-9363
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 85
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City | NORTH HARTLAND
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State | VT
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Zip | 05052-0085
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Country | US
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Telephone | 413-931-1776
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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 |
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License Number State |
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