Provider Demographics
NPI:1194306944
Name:ALBONICO, KELLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:ALBONICO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SIERRA BLANCA
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9445
Mailing Address - Country:US
Mailing Address - Phone:415-246-8530
Mailing Address - Fax:
Practice Address - Street 1:36 SIERRA BLANCA
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9445
Practice Address - Country:US
Practice Address - Phone:415-246-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist