Kelsey Ott-Sudik
Individual provider Active NPI Clinical Social Worker · Old Lyme, CT
NPI 1821532904 · NPPES record last updated Dec 8, 2016
Key facts
- NPI
- 1821532904
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- SW131918 (PA)
- Practice address
- 55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534 - Phone
- (800) 370-3651
- Fax
- (877) 515-7147
- NPI assigned
- Dec 8, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW131918 | PA | MD | Clinical Social Worker |
Interoperability endpoints
- dcp.kelseyott-sudik@141748.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW131918 | PA | Yes |
Addresses
Primary practice location
55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534
Mailing address
55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534
Phone (800) 370-3651
Other providers in Old Lyme, CT
- Old Lyme Dental Associates LLC
- Old Lyme South End Volunteer Ambulance
- Tracie Ortoleva
- Evelyn Darlene Ososkie
- Susan M Ostrowski
- Katherine Palko
- Anisha Rajesh Parekh
- Jonathan Patrick
- Pearl ABA LLC
- Linda J Pelletier
All providers in Old Lyme, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.