Provider Demographics
NPI:1689973604
Name:KELLY, DENA ELIZABETH (MA)
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MCDERMOTT DR
Mailing Address - Street 2:#214
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4022
Mailing Address - Country:US
Mailing Address - Phone:610-430-5678
Mailing Address - Fax:
Practice Address - Street 1:1160 MCDERMOTT DR
Practice Address - Street 2:#214
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4022
Practice Address - Country:US
Practice Address - Phone:610-430-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst