Provider Demographics
NPI:1992919534
Name:JELLEY, DENISE KATHERINE (LCSW R)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:KATHERINE
Last Name:JELLEY
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BONTICOU VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW DALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-255-2465
Mailing Address - Fax:
Practice Address - Street 1:9 BONTECOU VIEW DR
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1004
Practice Address - Country:US
Practice Address - Phone:845-255-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR06316111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical