Provider Demographics
NPI:1366963761
Name:BORGHI, KELLY VANESSA (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:VANESSA
Last Name:BORGHI
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 1:5906 ELAINE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2467
Mailing Address - Country:US
Mailing Address - Phone:224-856-7560
Mailing Address - Fax:815-669-4053
Practice Address - Street 1:5906 ELAINE DR STE 105
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2467
Practice Address - Country:US
Practice Address - Phone:224-856-7560
Practice Address - Fax:815-669-4053
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0207791041C0700X
IL1490207791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical