Provider Demographics
NPI:1457368714
Name:KELLY, JUDY A
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:A
Last Name:KELLY
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 1:229 E 28 ST
Mailing Address - Street 2:#LD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8565
Mailing Address - Country:US
Mailing Address - Phone:212-252-8921
Mailing Address - Fax:
Practice Address - Street 1:229 E 28 ST
Practice Address - Street 2:APT LD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8565
Practice Address - Country:US
Practice Address - Phone:212-252-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000885-1101YM0800X
NJ37PC00304800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional