Provider Demographics
NPI:1275762031
Name:KELLEY, WILLIAM DANIEL JR (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DANIEL
Last Name:KELLEY
Suffix:JR
Gender:M
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MERCHANTS ROW
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-775-8080
Mailing Address - Fax:
Practice Address - Street 1:120 MERCHANTS ROW
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5911
Practice Address - Country:US
Practice Address - Phone:802-775-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health