Provider Demographics
NPI:1407617061
Name:KELLY, KATHLEEN LYNCH (PHD, CADC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LYNCH
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHD, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 EATON WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6929
Mailing Address - Country:US
Mailing Address - Phone:267-619-5522
Mailing Address - Fax:
Practice Address - Street 1:447 EATON WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6929
Practice Address - Country:US
Practice Address - Phone:267-619-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA14792101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)