MEDICARE: KIMBERLY 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
1	1041C0700X	Clinical Social Worker	6238	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801516570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KELLY LCSW

Provider Business Mailing Address
First Line	:	67 CARILLON DR UNIT A
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-2501
Country	:	US
Telephone Number	:	860-965-2690
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 CARILLON DR UNIT A
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-2501
Country	:	US
Telephone Number	:	860-965-2690
Fax Number	:

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

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	06/09/2026

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