Provider Demographics
NPI:1396905436
Name:KELLY, MARJORIE ROSE (MSED)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ROSE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1266
Mailing Address - Country:US
Mailing Address - Phone:412-488-4098
Mailing Address - Fax:412-488-4097
Practice Address - Street 1:330 S 9TH STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203
Practice Address - Country:US
Practice Address - Phone:412-488-4098
Practice Address - Fax:412-488-4097
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health