Provider Demographics
NPI:1326496274
Name:GARRAHAN, KELLY L
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:GARRAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LLEWELLYN ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTER HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19017-0109
Mailing Address - Country:US
Mailing Address - Phone:610-209-2406
Mailing Address - Fax:
Practice Address - Street 1:240 LLEWELYN ROAD
Practice Address - Street 2:
Practice Address - City:CHESTER HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19017
Practice Address - Country:US
Practice Address - Phone:610-209-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003097103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH003097OtherSTATE LICENSE