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NPI Code Detail

MEDICARE: MS. KELLY LEA DEFILLIPPO BSW

MEDICARE: MS. KELLY LEA DEFILLIPPO BSW
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2328834D024298OTHERPAVALUE BEHAVIORAL HEALTH

General Provider Information

NPI Number : 1386627230
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY LEA DEFILLIPPO BSW
Provider Business Mailing Address
First Line : 1070 OLD NATIONAL PIKE
Second Line :
City : FREDERICKTOWN
State : PA
Zip : 15333-2114
Country : US
Telephone Number : 724-632-6801
Fax Number : 724-632-6312
Provider Business Practice Location Address
First Line : 1152 WOOD ST
Second Line :
City : CALIFORNIA
State : PA
Zip : 15419-1260
Country : US
Telephone Number : 724-938-2099
Fax Number : 724-938-3221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 04/11/2008

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