Provider Demographics
NPI:1477697878
Name:KELLEY, ROBERT O (MED)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:O
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 LEE HOOK RD
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03824-6415
Mailing Address - Country:US
Mailing Address - Phone:603-682-8265
Mailing Address - Fax:603-679-5869
Practice Address - Street 1:225 LEE HOOK RD
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:NH
Practice Address - Zip Code:03824-6415
Practice Address - Country:US
Practice Address - Phone:603-682-8265
Practice Address - Fax:603-679-5869
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH017101YA0400X
NH096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health