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Contact Information

SUSAN KELLY, LICSW
42 WENDELL AVENUE
PITTSFIELD, MA01201
 Phone: 413-281-8984
 Fax: 413-496-9116
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for SUSAN KELLY · (Female)

NPI Number 1043386246
Status Active
Credentials LICSW (Licensed Independent Clinical Social Worker)
Entity Individual
Enumeration date 11/28/2006
Last updated 07/09/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • MA License # 111523
  • MA Medicaid 1855417
  • MA Other P08627 BCBSMA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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