| Doctor Name: | MS. SUSAN KELLY |
| NPI Number: | 1043484702 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC, CAC |
| License Number: | 000634 |
| Business Practice Address: | 1890 Dixwell Ave Hamden, CT - 065143122 |
| Business Phone Number: | 8602239291 |
| Business Fax Number: | 8602233111 |
| Mailing Address: | 1890 Dixwell Ave, HAMDEN |
| State: | CT |
| Postal Code: | 065143122 |
| Phone Number: | 8602239291 |
| Fax Number: | 8602233111 |
| NPI Enumeration Date: | 04/14/2008 |
| NPI Last Update Date: | 04/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 000634 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |