Provider Demographics
NPI:1164045324
Name:KELLEY, KRISTY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LINDEN OAKS STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2831
Mailing Address - Country:US
Mailing Address - Phone:585-586-1600
Mailing Address - Fax:585-586-7951
Practice Address - Street 1:100 LINDEN OAKS STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2831
Practice Address - Country:US
Practice Address - Phone:585-586-1600
Practice Address - Fax:585-586-7951
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NYP117744103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program