Provider Demographics
NPI:1932935954
Name:STOREY, KELLEY MARIE (LSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:STOREY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:MARIE
Other - Last Name:GERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:75 E MAIDEN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4963
Mailing Address - Country:US
Mailing Address - Phone:724-228-2200
Mailing Address - Fax:
Practice Address - Street 1:75 E MAIDEN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4963
Practice Address - Country:US
Practice Address - Phone:724-228-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker