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General NPI Number Information
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NPI Number | 1346172236
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Entity Type | Individual
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Provider Name | KELLY MARIE DEVINE
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Gender | Female
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 15 RIVERSIDE DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2742
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Country | US
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Telephone | 607-217-4170
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Fax | 607-238-1765
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Provider Business Mailing Address
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Address Line | 512 CENTRAL ST
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City | ENDICOTT
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State | NY
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Zip | 13760-4903
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Country | US
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Telephone | 607-341-1632
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 013595
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License Number State | NY
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