Provider Demographics
NPI:1285153676
Name:ESPOSITO, KELLY ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 OAK ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-9619
Mailing Address - Country:US
Mailing Address - Phone:315-901-2300
Mailing Address - Fax:
Practice Address - Street 1:3650 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2465
Practice Address - Country:US
Practice Address - Phone:315-901-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-17
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085893-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical