Provider Demographics
NPI:1831562784
Name:KELLY, SUSAN STRAUSS (LSW, CCTP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:STRAUSS
Last Name:KELLY
Suffix:
Gender:F
Credentials:LSW, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ALDWYN LANE
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085
Mailing Address - Country:US
Mailing Address - Phone:610-213-2474
Mailing Address - Fax:610-520-9495
Practice Address - Street 1:1503 MCDANIEL DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6671
Practice Address - Country:US
Practice Address - Phone:610-213-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-31
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132510104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker