Provider Demographics
NPI:1174882419
Name:MCCLAIN, KELSEY RAE (MSW,LISW-S)
Entity type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:RAE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:MSW,LISW-S
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:RAE
Other - Last Name:D'AMICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LISW-S
Mailing Address - Street 1:1044 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1006
Mailing Address - Country:US
Mailing Address - Phone:330-480-8015
Mailing Address - Fax:330-480-4398
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-480-8015
Practice Address - Fax:330-480-4398
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.120413-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical