Healthcare Provider Details

I. General information

NPI: 1003646340
Provider Name (Legal Business Name): SEAN STEPHEN KELLY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 ERLEN RD
ELKINS PARK PA
19027-1062
US

IV. Provider business mailing address

1711 ERLEN RD
ELKINS PARK PA
19027-1062
US

V. Phone/Fax

Practice location:
  • Phone: 215-589-9970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017983
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01041900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: