Provider Demographics
NPI:1528564481
Name:MAYER, KELLY DARLENE (LMHC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DARLENE
Last Name:MAYER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N WEST ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1068
Mailing Address - Country:US
Mailing Address - Phone:607-662-4141
Mailing Address - Fax:
Practice Address - Street 1:6 N WEST ST STE 5
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1068
Practice Address - Country:US
Practice Address - Phone:607-662-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008507-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health