Kelly Kristina Kolodziejski, LCSW
Individual provider Active NPI Clinical Social Worker · Liverpool, NY
NPI 1598038374 · NPPES record last updated May 23, 2019
Key facts
- NPI
- 1598038374
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 083431 (NY)
- Practice address
- 916 Old Liverpool Rd Ste B
Liverpool, NY 13088-8536 - Phone
- (315) 743-4042
- NPI assigned
- Feb 9, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150917002390 | NY | Practitioner - Clinical Social Worker | 9638486061 | Practice locations: Liverpool, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 083431 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelly Kolodziejski LCSW R | Clinical | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 083431 | NY | Yes |
Addresses
Primary practice location
916 Old Liverpool Rd Ste B
Liverpool, NY 13088-8536
Mailing address
916 Old Liverpool Rd Ste B
Liverpool, NY 13088-8536
Phone (315) 743-4042
Other providers in Liverpool, NY
- Joseph L Kinsley
- Jessica Kish
- Steven Anthony Klink
- Samantha Marie Knapp
- Daisy Dawoon Ko
- Kyle Kowalewski
- Lisa R Kozma
- KPH Healthcare Services, Inc.
- KPH Healthcare Services, Inc.
- Lauren Michelle Kraus
All providers in Liverpool, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.