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Individual
BREANNA KELLY
Active
Individual
BREANNA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11833409
—
104100000X
Social Worker
MSW006385
GA
1041C0700X
Clinical Social Worker
CSW005955
GA
Other
Enumeration date
08/09/2016
Last updated
06/02/2025
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