Provider Demographics
NPI:1558050435
Name:KELLEY, ERIN MARIA I
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MARIA
Last Name:KELLEY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BERKLEY DR
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1444
Mailing Address - Country:US
Mailing Address - Phone:917-497-7337
Mailing Address - Fax:
Practice Address - Street 1:6 BERKLEY DR
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1444
Practice Address - Country:US
Practice Address - Phone:917-497-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency