Individual
EILEEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1509 MAPLE ST, SCRANTON, PA 18505-2707
(570) 342-8305
Mailing address
336 BUTTERNUT FLTS, HONESDALE, PA 18431-3062
(570) 647-7725
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW136231
PA
1041C0700X
Clinical Social Worker
Primary
CW023331
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100759410-0018
—
PA
05
—
100759410-0048
—
PA
Enumeration date
08/20/2019
Last updated
04/02/2025
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