Provider Demographics
NPI:1659424620
Name:KIELY, ROSANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:
Last Name:KIELY
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 1:55 OLD TURNPIKE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2461
Mailing Address - Country:US
Mailing Address - Phone:845-627-2814
Mailing Address - Fax:
Practice Address - Street 1:55 OLD TURNPIKE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2461
Practice Address - Country:US
Practice Address - Phone:845-627-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013427-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV79851Medicare ID - Type Unspecified