Individual
EPHRAIM KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1235 SPRING GARDEN ST, PHILADELPHIA, PA 19123-3206
(215) 769-3561
(215) 769-3860
Mailing address
1235 SPRING GARDEN ST, PHILADELPHIA, PA 19123-3206
(215) 769-3561
(215) 769-3860
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024869940001
—
PA
Enumeration date
05/14/2018
Last updated
05/14/2018
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