Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | NJ |
NPI | 1184642597 |
---|---|
Provider Name | Dr. J. Patrick Kelly |
First Address | Elmwood Park, NJ 07407-3126 |
Second Address | Elmwood Park, NJ 07407-3126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |