Provider Demographics
NPI:1093776270
Name:KELLEY, JANET K (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:K
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-1208
Mailing Address - Country:US
Mailing Address - Phone:717-232-7509
Mailing Address - Fax:717-232-4597
Practice Address - Street 1:2101 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1086
Practice Address - Country:US
Practice Address - Phone:717-635-2574
Practice Address - Fax:717-671-7167
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003609L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical