Provider Demographics
NPI:1164256467
Name:CAIN, KELLEY (LICSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROSEMAR CIR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1203
Mailing Address - Country:US
Mailing Address - Phone:304-422-7999
Mailing Address - Fax:681-661-0257
Practice Address - Street 1:7 ROSEMAR CIR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1203
Practice Address - Country:US
Practice Address - Phone:304-422-7999
Practice Address - Fax:681-661-0257
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009455781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical