Provider Demographics
NPI:1063173623
Name:KELLY, SUSAN JOAN (AMFT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOAN
Last Name:KELLY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UPLIFT FAMILY SERVICES
Mailing Address - Street 2:499 LOMA ALTA AVE
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030
Mailing Address - Country:US
Mailing Address - Phone:408-364-4157
Mailing Address - Fax:
Practice Address - Street 1:UPLIFT FAMILY SERVICES
Practice Address - Street 2:499 LOMA ALTA AVE
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030
Practice Address - Country:US
Practice Address - Phone:408-364-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst