Kelly, Jerry S
Kelly, Jerry S is an individual health care provider with primary practice located at 3719 Union Rd , Cheektowaga NY 14225-4249. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Kelly, Jerry S can be contacted via phone (716) 681-7394.Contact Information
Primary practice address
3719 Union Rd
Cheektowaga NY 14225-4249
Phone: (716) 681-7394
Fax: (716) 685-9087
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 00003961 | New York |
Profile Details
| NPI number | 1962559278 |
|---|---|
| LBN Legal business name | Kelly, Jerry S |
| Credentials | LCSW-R |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 5th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 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 | 1962559278 | NPPES |
| New York | Other | 00030241501 | UNIVERA |
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