Provider Demographics
NPI:1316429566
Name:NOGA, KELLY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:NOGA
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:228 STRATTON BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2426
Mailing Address - Country:US
Mailing Address - Phone:413-454-5080
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE ST STE 325
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2215
Practice Address - Country:US
Practice Address - Phone:413-737-9544
Practice Address - Fax:413-737-4455
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2248731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical