Provider Demographics
NPI:1518192228
Name:KELLEY, MURRAY OWEN (LCSW, MS(ED))
Entity Type:Individual
Prefix:MR
First Name:MURRAY
Middle Name:OWEN
Last Name:KELLEY
Suffix:
Gender:M
Credentials:LCSW, MS(ED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W 112TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1898
Mailing Address - Country:US
Mailing Address - Phone:212-875-4573
Mailing Address - Fax:212-875-4566
Practice Address - Street 1:610 W 112TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1898
Practice Address - Country:US
Practice Address - Phone:212-875-4573
Practice Address - Fax:212-875-4566
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069474-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist