Provider Demographics
NPI:1295788420
Name:KELLEY, TIMOTHY S (MSW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:S
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 N MILITARY TRL
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-7417
Mailing Address - Country:US
Mailing Address - Phone:561-422-6426
Mailing Address - Fax:561-422-5309
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-6426
Practice Address - Fax:561-422-5309
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical