Provider Demographics
NPI:1174131841
Name:CIPERA, KELLY L (LCSW, LISW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:CIPERA
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 BALLS FORD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2517
Mailing Address - Country:US
Mailing Address - Phone:571-469-7106
Mailing Address - Fax:
Practice Address - Street 1:10432 BALLS FORD RD STE 300
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:571-469-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040121071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.2203500OtherLICENSED INDEPENDENT SOCIAL WORKER
VA0904012107OtherLICENCED CLINICAL SOCIAL WORKER