Provider Demographics
NPI:1407448608
Name:KELSO, REBECCA (MHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KELSO
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 CENTRAL PARK W APT 20L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5878
Mailing Address - Country:US
Mailing Address - Phone:808-271-2936
Mailing Address - Fax:
Practice Address - Street 1:30 E END AVE APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7097
Practice Address - Country:US
Practice Address - Phone:917-670-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health