MEDICARE: KELLY DEGIULIO MSW,LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW03686	RI

General Provider Information

NPI Number	:	1215478102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY DEGIULIO MSW,LCSW

Provider Business Mailing Address
First Line	:	455 TOLL GATE ROAD
Second Line	:	PRC AND CREDENTIAILNG
City	:	WARWICK
State	:	RI
Zip	:	02886-2759
Country	:	US
Telephone Number	:	401-273-0641
Fax Number	:	401-273-2919

Provider Business Practice Location Address
First Line	:	455 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2759
Country	:	US
Telephone Number	:	401-737-7010
Fax Number	:	401-736-4546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	04/22/2026

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