Provider Demographics
NPI:1760287809
Name:JONDRO, KELLIE ANNE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANNE
Last Name:JONDRO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RESERVOIR AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6032
Mailing Address - Country:US
Mailing Address - Phone:401-259-0340
Mailing Address - Fax:401-213-8538
Practice Address - Street 1:1150 RESERVOIR AVE STE 203
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6032
Practice Address - Country:US
Practice Address - Phone:401-259-0340
Practice Address - Fax:401-213-8538
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63551041C0700X
RIISW044601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical