Provider Demographics
NPI:1871630681
Name:FREDERICK-CASTRO, KELLY JEAN (LMSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JEAN
Last Name:FREDERICK-CASTRO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-8766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:350 NORTH MAIN STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-593-5251
Practice Address - Fax:734-593-5255
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker