Provider Demographics
NPI:1356720080
Name:NORCROSS, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NORCROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E 17TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1281
Mailing Address - Country:US
Mailing Address - Phone:718-233-2533
Mailing Address - Fax:718-233-2584
Practice Address - Street 1:1670 E 17TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1281
Practice Address - Country:US
Practice Address - Phone:718-233-2533
Practice Address - Fax:718-233-2584
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)