Provider Demographics
NPI:1972845162
Name:ERBLAND, KELLY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:ERBLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:95 ALLENS CREEK RD BLDG 2 STE 326
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3246
Mailing Address - Country:US
Mailing Address - Phone:518-479-9670
Mailing Address - Fax:
Practice Address - Street 1:95 ALLENS CREEK RD BLDG 2 SUITE 326
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:518-479-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080380-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker