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General NPI Number Information
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NPI Number | 1093847584
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Entity Type | Individual
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Provider Name | KEVIN J. KELLEY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 530 UNION BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18109-3230
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Country | US
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Telephone | 610-435-1541
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Fax | 610-435-4367
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Provider Business Mailing Address
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Address Line | 530 UNION BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18109-3230
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Country | US
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Telephone | 610-435-1541
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Fax | 610-435-4367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | PS005818L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS005818L
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License Number State | PA
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