Provider Demographics
NPI:1710569504
Name:KELLY, LEON C (MS)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:C
Last Name:KELLY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MCCOLLEY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-2067
Mailing Address - Country:US
Mailing Address - Phone:302-450-0115
Mailing Address - Fax:
Practice Address - Street 1:256 CHAPMAN RD STE 1052-2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5499
Practice Address - Country:US
Practice Address - Phone:302-689-3562
Practice Address - Fax:302-294-1757
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor