Provider Demographics
NPI:1144930124
Name:ZANDO, KELLY MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:ZANDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BROOKBEND DR
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3011
Mailing Address - Country:US
Mailing Address - Phone:203-610-7317
Mailing Address - Fax:
Practice Address - Street 1:110 BROOKBEND DR
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-3011
Practice Address - Country:US
Practice Address - Phone:203-610-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41321041S0200X
CTMSW.004132104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty