| Doctor Name: | MR. KENNETH GREGORY KELLY |
| NPI Number: | 1205052487 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYCHOLOGIST-M.A. |
| License Number: | |
| Business Practice Address: | 2297 Knowles Flat Rd Eden, VT - 05652 |
| Business Phone Number: | 8026359595 |
| Business Fax Number: | 8026357755 |
| Mailing Address: | Po Box 1401, MORRISVILLE |
| State: | VT |
| Postal Code: | 056611401 |
| Phone Number: | 8026359595 |
| Fax Number: | 8026357755 |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |