Provider Demographics
NPI:1720117187
Name:KELLEY, DEANE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEANE
Middle Name:M
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 ROOSEVELT PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3823
Mailing Address - Country:US
Mailing Address - Phone:504-301-2190
Mailing Address - Fax:504-301-2190
Practice Address - Street 1:8403 WILLOW ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1339
Practice Address - Country:US
Practice Address - Phone:504-319-5476
Practice Address - Fax:504-301-2190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA211040OtherCLINICAL PSYCHOLOGIST
LA1124869Medicaid
LA283194OtherCLINICAL PSYCHOLOGIST
LAG6251OtherCLINICAL PSYCHOLOGIST
LA283194OtherCLINICAL PSYCHOLOGIST
LA1124869Medicaid