Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS-002722-L | PA |
NPI | 1013015908 |
---|---|
Provider Name | Dr. William J Kelly |
First Address | Coopersburg, PA 18036-0182 |
Second Address | Coopersburg, PA 18036-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |