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General NPI Number Information
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NPI Number | 1497209167
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Entity Type | Individual
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Provider Name | KELLY MEANY LMSW, LADC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 30 OLD KINGS HWY RD
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City | DANEN
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State | CT
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Zip | 06820
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Country | US
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Telephone | 203-984-1994
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Fax | 703-202-2209
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Provider Business Mailing Address
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Address Line | 30 OLD KINGS HWY RD
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City | DANEN
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State | CT
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Zip | 06820
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Country | US
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Telephone | 203-984-1994
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Fax | 703-202-2209
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1330
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 098303
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License Number State | NY
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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 | 11495
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License Number State | CT
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