Individual
KIMBERY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1 RIVERSIDE DR, EAST HARTFORD, CT 06118-1837
(860) 929-3162
Mailing address
763 BURNSIDE AVE, EAST HARTFORD, CT 06108-2791
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6238
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008001955
—
CT
Enumeration date
09/01/2022
Last updated
09/01/2022
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