Individual
DR. KEVIN WILLIAM KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
2013 STATE STREET, EAST PETERSBURG, PA 17520-1216
(717) 291-8283
(717) 581-6528
Mailing address
2013 STATE STREET, EAST PETERSBURG, PA 17520-1216
(717) 291-8283
(717) 581-6528
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS-008835-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000411068
HIGHMARK BLUE SHIELD #
PA
01
—
01786901
CAPITAL BLUE CROSS PROV#
PA
01
—
02695800
CAPITAL BLUE CROSS PRACT#
PA
01
—
458436
VALUE OPTIONS PROV #
PA
01
—
P00180931
RAILROAD MEDICARE PROV #
PA
Enumeration date
08/02/2006
Last updated
02/10/2010
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