Provider Demographics
NPI:1205850021
Name:KELLY, BONNIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:KELLY
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 1:26 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1304
Mailing Address - Country:US
Mailing Address - Phone:215-860-4810
Mailing Address - Fax:
Practice Address - Street 1:26 EAGLE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1304
Practice Address - Country:US
Practice Address - Phone:215-860-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8602101YM0800X
NYMH001120-1101YM0800X
PAPC0000710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional