MEDICARE: LAUREN KELLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891377859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN KELLEY

Provider Business Mailing Address
First Line	:	3821 LANCASTER PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-1512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 CAPITOL TRL
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-5709
Country	:	US
Telephone Number	:	833-886-2277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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Directions to “ LAUREN KELLEY ” Practice Location

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