MEDICARE: MS. KELLY J SITTERLY 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	104100000X	Social Worker	099637-1	NY
2	1041C0700X	Clinical Social Worker	091396	NY

General Provider Information

NPI Number	:	1457845364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY J SITTERLY LCSW

Provider Business Mailing Address
First Line	:	301 N WASHINGTON ST STE 2470
Second Line	:
City	:	HERKIMER
State	:	NY
Zip	:	13350-1299
Country	:	US
Telephone Number	:	315-867-1465
Fax Number	:	315-867-1469

Provider Business Practice Location Address
First Line	:	301 N WASHINGTON ST STE 2470
Second Line	:
City	:	HERKIMER
State	:	NY
Zip	:	13350-1299
Country	:	US
Telephone Number	:	315-867-1465
Fax Number	:	315-867-1469

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/11/2025

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