Provider Demographics
NPI:1356591150
Name:CRANEY, KELLY NICOLE (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:CRANEY
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 STREET RD
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3796
Mailing Address - Country:US
Mailing Address - Phone:267-987-3524
Mailing Address - Fax:267-684-6810
Practice Address - Street 1:501 STREET RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3796
Practice Address - Country:US
Practice Address - Phone:267-987-3524
Practice Address - Fax:267-684-6810
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional