Individual
MS. STEPHANIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1300 CAMINO SIERRA VIS, 129, SANTA FE, NM 87505-1007
(505) 310-2571
Mailing address
PO BOX 31473, SANTA FE, NM 87594-1473
(505) 310-2571
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
M-0123
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M-05273
—
NM
Enumeration date
04/10/2007
Last updated
07/08/2007
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