Provider Demographics
NPI:1003078650
Name:KELLY, DIONNE
Entity Type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CONEY ISLAND AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2329
Mailing Address - Country:US
Mailing Address - Phone:347-563-9916
Mailing Address - Fax:718-998-2156
Practice Address - Street 1:13325 220TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1636
Practice Address - Country:US
Practice Address - Phone:347-563-9916
Practice Address - Fax:718-998-2156
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health