Provider Demographics
NPI:1154453231
Name:BHATNAGAR, KELLY ANNE CONSTANT (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE CONSTANT
Last Name:BHATNAGAR
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 1:3659 GREEN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5715
Mailing Address - Country:US
Mailing Address - Phone:216-233-6404
Mailing Address - Fax:216-765-0521
Practice Address - Street 1:3659 GREEN RD STE 102
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5715
Practice Address - Country:US
Practice Address - Phone:216-233-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3681103TC0700X
OH6891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical