Provider Demographics
NPI:1174687644
Name:O'CONNOR-KALIL, KELLY ROSE (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ROSE
Last Name:O'CONNOR-KALIL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ROSE
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:48 KIWASSA RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-2350
Mailing Address - Country:US
Mailing Address - Phone:518-891-0653
Mailing Address - Fax:
Practice Address - Street 1:2217 STATE ROUTE 86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-891-5535
Practice Address - Fax:518-891-5851
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health