MEDICARE: MR. KELLY CRAIG JONES L.C.S.W.

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	LCS17117	CA
2	1041C0700X	Clinical Social Worker	17117	CA

General Provider Information

NPI Number	:	1699899757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KELLY CRAIG JONES L.C.S.W.

Provider Business Mailing Address
First Line	:	587 N RAYMOND AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3460
Country	:	US
Telephone Number	:	626-622-8176
Fax Number	:

Provider Business Practice Location Address
First Line	:	587 N RAYMOND AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3460
Country	:	US
Telephone Number	:	626-622-8176
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	03/24/2026

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