# MS. KELLY A MADDALENA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1093709164
- **Gender:** F
- **Credential:** LCSW, LMHP, LIMHP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 509 | NE | — |
| 104100000X | Social Worker | 1006 | NE | — |
| 1041C0700X | Clinical Social Worker | 1006 | NE | Yes |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 11/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 85120 | BCBS | — |