Provider Demographics
NPI:1043349152
Name:KELLY, BARBARA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:H
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1810 AVENIDA DEL MUNDO
Mailing Address - Street 2:UNIT 807
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3003
Mailing Address - Country:US
Mailing Address - Phone:619-890-8491
Mailing Address - Fax:619-435-1456
Practice Address - Street 1:2645 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6506
Practice Address - Country:US
Practice Address - Phone:619-890-8491
Practice Address - Fax:619-435-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY18148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18148OtherCA STATE LICENSE NUMBER