Doctor Name: | DR. EILEEN MARIE LEARY KELLY |
NPI Number: | 1528398377 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 003089-1 |
Business Practice Address: | 137 Fishback Rd Middle Grove, NY - 128502424 |
Business Phone Number: | 5188932012 |
Business Fax Number: | 5188932558 |
Mailing Address: | 137 Fishback Rd, MIDDLE GROVE |
State: | NY |
Postal Code: | 128502424 |
Phone Number: | 5188932012 |
Fax Number: | 5188932558 |
NPI Enumeration Date: | 12/29/2009 |
NPI Last Update Date: | 12/29/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 003089-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |