Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003078650 |
---|---|
Provider Name | Ms. Dionne Kelly |
First Address | Brooklyn, NY 11223-2329 |
Second Address | Springfield Gardens, NY 11413-1636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 13/06/2013 |