Provider Demographics
NPI:1235571688
Name:RICHARDS, KELLY C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:C
Last Name:RICHARDS
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 1:721 ORWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3124
Mailing Address - Country:US
Mailing Address - Phone:315-313-4031
Mailing Address - Fax:
Practice Address - Street 1:721 ORWOOD PL
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-3124
Practice Address - Country:US
Practice Address - Phone:315-313-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019444-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical