Provider Demographics
NPI:1124326236
Name:KELLY, INEZ N/A (MA)
Entity type:Individual
Prefix:MISS
First Name:INEZ
Middle Name:N/A
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:INEZ
Other - Middle Name:N/A
Other - Last Name:FELICIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 TYBEE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-2871
Mailing Address - Country:US
Mailing Address - Phone:561-727-7199
Mailing Address - Fax:
Practice Address - Street 1:5305 GREENWOOD AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2448
Practice Address - Country:US
Practice Address - Phone:561-557-6657
Practice Address - Fax:561-557-6711
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor