Provider Demographics
NPI:1154621480
Name:KELLEY, BRIEN SHARP (PHD)
Entity type:Individual
Prefix:
First Name:BRIEN
Middle Name:SHARP
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 W 12TH ST
Mailing Address - Street 2:APT. 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8651
Mailing Address - Country:US
Mailing Address - Phone:347-443-9643
Mailing Address - Fax:
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4709
Practice Address - Country:US
Practice Address - Phone:347-443-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical