Provider Demographics
NPI:1295034817
Name:KELLY, ERIN-LEE (MA NCP-GSA)
Entity Type:Individual
Prefix:
First Name:ERIN-LEE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA NCP-GSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4222
Mailing Address - Country:US
Mailing Address - Phone:484-485-6882
Mailing Address - Fax:
Practice Address - Street 1:4700 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4222
Practice Address - Country:US
Practice Address - Phone:484-485-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health