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General NPI Number Information
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NPI Number | 1821402132
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Entity Type | Individual
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Provider Name | SONYA MARIA KELLY PHD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 3558 ROUND BARN BLVD, SUITE 200
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City | SANTA ROSA
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State | CA
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Zip | 95403
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Country | US
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Telephone | 707-292-6714
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Fax | 707-664-9626
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Provider Business Mailing Address
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Address Line | P.O. BOX 156
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City | COTATI
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State | CA
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Zip | 94931
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Country | US
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Telephone | 707-321-6997
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Fax | 707-664-9626
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY17700
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License Number State | CA
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