MEDICARE: KELLEY HUNT 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	0904008224	VA

General Provider Information

NPI Number	:	1487085163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY HUNT LCSW

Provider Business Mailing Address
First Line	:	509 PARK ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-4739
Country	:	US
Telephone Number	:	434-996-2731
Fax Number	:	434-293-2310

Provider Business Practice Location Address
First Line	:	509 PARK ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-4739
Country	:	US
Telephone Number	:	434-996-2731
Fax Number	:	434-293-2310

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

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	10/20/2020

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