Individual ProviderColleen KellySocial WorkerBehavioral Health & Social Service ProvidersPractice Address7701 13th Ave, Brooklyn, NY 11228-24131823213517PECOS EnrollmentBased on the most recent information from CMS, provider Colleen Kelly is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:18 AM.Profile DetailsProvider ID1205440591Provider TypeIndividualFull NameKelly, ColleenCredentialLCSWGenderFemaleSole ProprietorNoEnumeration Date9/3/2020Last Updated5/28/2024Contact InformationPractice LocationPractice Address7701 13th Ave, Brooklyn, NY 11228-2413Phone1823213517FaxUnlisted FaxMailing LocationMailing Address7701 13th Ave, Brooklyn, NY 11228-2413Phone1823213517FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense097696New YorkCode104100000XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense110092New York