Individual
DEIDRA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1623 FLATBUSH AVE, BROOKLYN, NY 11210-3262
(718) 530-4228
Mailing address
1623 FLATBUSH AVE, BROOKLYN, NY 11210-3262
(917) 671-6315
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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