| Doctor Name: | DR. KEVIN WILLIAM KELLY |
| NPI Number: | 1619984309 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | PS-008835-L |
| Business Practice Address: | 2013 State Street East Petersburg, PA - 175201216 |
| Business Phone Number: | 7172918283 |
| Business Fax Number: | 7175816528 |
| Mailing Address: | 2013 State Street, EAST PETERSBURG |
| State: | PA |
| Postal Code: | 175201216 |
| Phone Number: | 7172918283 |
| Fax Number: | 7175816528 |
| NPI Enumeration Date: | 08/02/2006 |
| NPI Last Update Date: | 02/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS-008835-L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |