Provider Demographics
NPI:1750401410
Name:MASSENELLI, KELLY (MSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MASSENELLI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:LOEFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:7750 DILEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7758
Mailing Address - Country:US
Mailing Address - Phone:614-837-7337
Mailing Address - Fax:614-837-7335
Practice Address - Street 1:4595 TRUEMAN BLVD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2576
Practice Address - Country:US
Practice Address - Phone:614-529-0771
Practice Address - Fax:614-529-2370
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00312731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid
OH2846675Medicaid