Provider Demographics
NPI:1992474514
Name:GLOSTER, KELLY J (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:GLOSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:GLOSTER-FADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:250 BEL AIR DR
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2730
Mailing Address - Country:US
Mailing Address - Phone:702-538-5087
Mailing Address - Fax:
Practice Address - Street 1:103 MYRON ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1598
Practice Address - Country:US
Practice Address - Phone:413-592-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MA2277601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker