Individual
BONNIE JEANNE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
708 MOBJACK PL, NEWPORT NEWS, VA 23606-1957
(757) 873-1958
(757) 873-2143
Mailing address
708 MOBJACK PL, NEWPORT NEWS, VA 23606-1957
(757) 873-1958
(757) 873-2143
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904000483
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008952914
—
VA
01
—
043493
VALUE OPTIONS
VA
01
—
2109871
MAMSI
VA
01
—
331939
ANTHEM BC/BS
VT
01
—
5359671
AETNA
VA
01
—
86862
SENTARA
VA
Enumeration date
06/30/2006
Last updated
02/07/2019
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