Provider Demographics
NPI:1760782395
Name:CAVALIERE, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:CAVALIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CLINTON AVE APT 1H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3508
Mailing Address - Country:US
Mailing Address - Phone:203-246-1756
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1506
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1115
Practice Address - Country:US
Practice Address - Phone:203-246-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080407104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker