Provider Demographics
NPI:1306938121
Name:KELLY, KERRY KATHERINE (MSW)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:KATHERINE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BOSTON POST RD
Mailing Address - Street 2:ERRERA COMMUNITY CARE CENTER
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2043
Mailing Address - Country:US
Mailing Address - Phone:203-640-6637
Mailing Address - Fax:203-931-4068
Practice Address - Street 1:114 BOSTON POST RD
Practice Address - Street 2:ERRERA COMMUNITY CARE CENTER
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2043
Practice Address - Country:US
Practice Address - Phone:203-640-6637
Practice Address - Fax:203-931-4068
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical