Individual
DR. KEVIN WILLIAM KELLY
Active
Individual
DR. KEVIN WILLIAM KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
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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