Provider Demographics
NPI:1366409849
Name:KELLY, GERALDINE CARMELA (MA)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:CARMELA
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARK CT
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4941
Mailing Address - Country:US
Mailing Address - Phone:610-323-8062
Mailing Address - Fax:
Practice Address - Street 1:1204 POTTSTOWN PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-9595
Practice Address - Country:US
Practice Address - Phone:610-458-1150
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006415L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist