Provider Demographics
NPI:1982472742
Name:RALEIGH, KELLY COSGROVE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:COSGROVE
Last Name:RALEIGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:THERESA
Other - Last Name:COSGROVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1890 N REVERE CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1890 N REVERE CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7464
Practice Address - Country:US
Practice Address - Phone:303-724-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYC.00015470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical