Provider Demographics
NPI:1215058706
Name:KELLEY, BETH MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 81ST ST
Mailing Address - Street 2:#56
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5833
Mailing Address - Country:US
Mailing Address - Phone:917-797-2886
Mailing Address - Fax:212-604-3259
Practice Address - Street 1:200 W 81ST ST
Practice Address - Street 2:#56
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5833
Practice Address - Country:US
Practice Address - Phone:917-797-2886
Practice Address - Fax:212-604-3259
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR058154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health