Brian Edward Kelly | Portland, OR • PECOS Search

Brian Edward Kelly

Social Worker

Behavioral Health & Social Service Providers

1904 SE Division St, Portland, OR 97202-1146

PECOS Enrollment

Based on the most recent information from CMS, provider Brian Edward Kelly does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1770861924
Provider Type
Individual
Full Name
Kelly, Brian Edward
Credential
MSW

Gender
Male
Sole Proprietor
Yes
Enumeration Date
7/21/2011
Last Updated
7/21/2011

Contact Information

Practice Location

1904 SE Division St, Portland, OR 97202-1146

Unlisted Fax

Mailing Location

1904 SE Division St, Portland, OR 97202-1146

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 104100000X Primary	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer