BRUCE ALLEN KELLEY MA, LSW, CDCA, NPI 1679891154 — TOLEDO (OH)

NPI 1679891154

9+ Years Experience Individual

BRUCE ALLEN KELLEY MA, LSW, CDCA

05.10.2010
PROVIDER ENUMERATION DATE
05.10.2010
LAST UPDATE DATE
1679891154
NPI NUMBER

About BRUCE ALLEN KELLEY

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

BRUCE ALLEN KELLEY is a provider established in TOLEDO, OH. The NPI number of BRUCE ALLEN KELLEY is 1679891154 and was assigned on 05.10.2010. The practitioners primary taxonomy code is: 1041C0700X with license number: S0020283 OH .

Mailing address

  • City: TOLEDO
  • State: OH
  • Postal code: 436052456
  • Phone: 4196930631
  • Fax: 4199367606
  • Address: 1425 STARR AVE

Primary Practice Address

  • Region : TOLEDO, OH
  • NPI : 1679891154
  • Phone : 4196930631
  • Fax : 4199367606
  • Postalcode : 436052456
  • Address : 1425 STARR AVE

Provider taxonomy - Social Worker

  • Taxonomy code: 1041C0700X
  • License number: S0020283
  • License state: OH

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A social worker who holds a master"s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master"s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Contacts:

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  • BRUCE ALLEN KELLEY MA, LSW, CDCA
  • Address : 1425 STARR AVE
  • Region : TOLEDO, OH
  • NPI : 1679891154
  • Phone : 4196930631
  • Fax : 4199367606
  • Postalcode : 436052456

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1425 STARR AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameTOLEDO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameOH
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code436052456
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number4196930631
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4199367606
The fax number associated with the location address of the provider being identified.
NPI1679891154
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 11041C0700X
A social worker who holds a master"s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master"s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Provider Enumeration Date05.10.2010
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated05.10.2010
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)BRUCE ALLEN KELLEY
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address1425 STARR AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameTOLEDO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameOH
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code436052456
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number4196930631
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number4199367606
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #11041C0700X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Social Worker
A social worker who holds a master"s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master"s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Provider License Number 1S0020283
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1OH
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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