Provider Demographics
NPI:1538240510
Name:URBANOWICZ, KELLY (LMHC, LPC)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:
Last Name:URBANOWICZ
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WANDA DR
Mailing Address - Street 2:
Mailing Address - City:BEACON FALLS
Mailing Address - State:CT
Mailing Address - Zip Code:06403-1532
Mailing Address - Country:US
Mailing Address - Phone:203-446-7461
Mailing Address - Fax:203-463-8745
Practice Address - Street 1:276 BANK ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2700
Practice Address - Country:US
Practice Address - Phone:203-446-7461
Practice Address - Fax:203-463-8745
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00169101YM0800X
CT002187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI486309OtherTUFTS TOTAL HEALTH PLAN
RI412332OtherBCBS BLUE CHIP
RI1031310OtherNHP-RI
RIKU53902Medicaid
RI27262-9OtherBCBS