Provider Demographics
NPI:1477822559
Name:KELLY, KATHERINE E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2508
Mailing Address - Country:US
Mailing Address - Phone:518-869-3006
Mailing Address - Fax:518-869-5891
Practice Address - Street 1:100 FOREST DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2508
Practice Address - Country:US
Practice Address - Phone:518-869-3006
Practice Address - Fax:518-869-5891
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017932103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool