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NPI Code Detail

MEDICARE: GWENDOLYN KELLY LCSW

MEDICARE: GWENDOLYN KELLY 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
1104100000XSocial WorkerSW136254PA
21041C0700XClinical Social WorkerCW027212PA

General Provider Information

NPI Number : 1790552578
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN KELLY LCSW
Provider Business Mailing Address
First Line : 907 WEST ST STE 247
Second Line :
City : PITTSBURGH
State : PA
Zip : 15221-2838
Country : US
Telephone Number : 412-528-6778
Fax Number :
Provider Business Practice Location Address
First Line : 907 WEST ST STE 247
Second Line :
City : PITTSBURGH
State : PA
Zip : 15221-2838
Country : US
Telephone Number : 412-528-6778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2023
Last Update Date : 03/11/2026

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Directions to “ GWENDOLYN KELLY LCSW” Practice Location

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