Provider Demographics
NPI:1083067060
Name:KELLEY, JANINE (NCC)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2406
Mailing Address - Country:US
Mailing Address - Phone:570-357-1165
Mailing Address - Fax:
Practice Address - Street 1:103 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2406
Practice Address - Country:US
Practice Address - Phone:570-357-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health