Kelly, Jacalyn P
Kelly, Jacalyn P is an individual health care provider with primary practice located at 3065 Southwestern Boulevard Suite 204, Orchard Park NY 14127. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Kelly, Jacalyn P can be contacted via phone (716) 675-9232.Contact Information
Primary practice address
3065 Southwestern Boulevard Suite 204
Orchard Park NY 14127
Phone: (716) 675-9232
Fax: (716) 675-9217
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | 0543871 | New York |
Profile Details
| NPI number | 1447322995 |
|---|---|
| LBN Legal business name | Kelly, Jacalyn P |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 13th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447322995 | NPPES |
| Other | 00026422101 | UNIVERA | |
| Other | 000540315001 | UNIVERA | |
| Other | 6212551 | UNIVERA |
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