=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386147635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY SALERNO LISW-S, LICDC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2018
-----------------------------------------------------
Last Update Date | 07/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9105 HARDING HWY RM K129
-----------------------------------------------------
City | HARROD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45850-9485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-224-4250
-----------------------------------------------------
Fax | 419-225-8878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 329 N WEST ST
-----------------------------------------------------
City | LIMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45801-4332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-221-3072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------