Provider Demographics
NPI:1417366105
Name:KELLY, PAUL (BA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1240
Mailing Address - Country:US
Mailing Address - Phone:201-297-5866
Mailing Address - Fax:
Practice Address - Street 1:1 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1240
Practice Address - Country:US
Practice Address - Phone:201-297-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health