Individual
DR. CAROL ANN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D.
Contact information
Practice address
10451 TENNESSEE AVE, LOS ANGELES, CA 90064-2329
(310) 475-7434
(310) 475-7844
Mailing address
10451 TENNESSEE AVE, LOS ANGELES, CA 90064-2329
(310) 475-7434
(310) 475-7844
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY 5359
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PSY 5359
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OOPL53590
MEDICAL
CA
Enumeration date
11/26/2007
Last updated
11/26/2007
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