Provider Demographics
NPI:1780003509
Name:KELLY-CADAVID, LAURA MEGHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MEGHAN
Last Name:KELLY-CADAVID
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MEGHAN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:24220 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1116
Mailing Address - Country:US
Mailing Address - Phone:917-833-3783
Mailing Address - Fax:
Practice Address - Street 1:24220 90TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1116
Practice Address - Country:US
Practice Address - Phone:917-833-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 020296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical