Provider Demographics
NPI:1821392747
Name:JUDE, KELLY (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:JUDE
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 1:32 W ALLENS LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1637
Mailing Address - Country:US
Mailing Address - Phone:267-291-4385
Mailing Address - Fax:
Practice Address - Street 1:8612 GERMANTOWN AVE # 2F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2874
Practice Address - Country:US
Practice Address - Phone:267-291-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0168221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical