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Provider Information for 1154763589


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CARYN KELLEY LCSW


Sex: Female

NPI: 1154763589
Last Updated: 2013-07-26
Certification Date:

Details

NameValue
NPI1154763589
Enumeration Date2013-07-26
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 607 7TH ST
WILMETTE, IL 60091-1919
United States

Phone: 847-251-0332 | Fax:847-251-0332
 
Primary Practice Address 607 7TH ST
WILMETTE, IL 60091-1919
United States

Phone: 847-251-0332 | Fax:847-251-0332
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)IL149.003207Licensed Clinical Social Worker
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalIL149.003207