Provider Demographics
NPI:1609599653
Name:KELLY, TIMOTHY JOSEPH (CASAC-T , BS, CDC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:KELLY
Suffix:
Gender:M
Credentials:CASAC-T , BS, CDC
Other - Prefix:
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Mailing Address - Street 1:41 PAGE PARK DR STE 7
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-7501
Mailing Address - Country:US
Mailing Address - Phone:845-486-2950
Mailing Address - Fax:845-486-2999
Practice Address - Street 1:41 PAGE PARK DR STE 7
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-7501
Practice Address - Country:US
Practice Address - Phone:845-486-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY34319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)