Healthcare Provider Details

I. General information

NPI: 1346574118
Provider Name (Legal Business Name): JENNIFER J KELLY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 BALLSTON AVE
SARATOGA SPRINGS NY
12866-4723
US

IV. Provider business mailing address

58 TYLER DR
SARATOGA SPRINGS NY
12866-8418
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-8008
  • Fax:
Mailing address:
  • Phone: 518-583-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000371-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: