Individual
KELLY KOSTELICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
833 CHESTNUT ST STE 210, PHILADELPHIA, PA 19107-4405
(215) 503-2838
Mailing address
2424 FRANKFORD AVE UNIT 3, PHILADELPHIA, PA 19125-1611
(717) 873-8801
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
CW20238
PA
Other
Enumeration date
12/20/2016
Last updated
07/01/2019
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