Doctor Name: | DR. WILLIAM J KELLY |
NPI Number: | 1013015908 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PS-002722-L |
Business Practice Address: | 343 S 3rd St Coopersburg, PA - 180362111 |
Business Phone Number: | 6102822575 |
Business Fax Number: | 6102823076 |
Mailing Address: | Po Box 182, COOPERSBURG |
State: | PA |
Postal Code: | 180360182 |
Phone Number: | 6104283903 |
Fax Number: | |
NPI Enumeration Date: | 09/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | PS-002722-L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |