MEDICARE: ANNE KELLY LSW, M.ED

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	44SL06550900	NJ
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1801252507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE KELLY LSW, M.ED

Provider Business Mailing Address
First Line	:	2913 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3016
Country	:	US
Telephone Number	:	215-634-5272
Fax Number	:	215-634-5271

Provider Business Practice Location Address
First Line	:	2913 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3016
Country	:	US
Telephone Number	:	215-589-5555
Fax Number	:	215-634-5271

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

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	02/01/2021

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