Provider Demographics
NPI:1316701055
Name:MCSPEDON, KELLY P (MS, MA, CAADC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:P
Last Name:MCSPEDON
Suffix:
Gender:F
Credentials:MS, MA, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 S CAMAC ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6208
Mailing Address - Country:US
Mailing Address - Phone:631-682-7499
Mailing Address - Fax:
Practice Address - Street 1:128 CHESTNUT ST STE 404B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3024
Practice Address - Country:US
Practice Address - Phone:267-341-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor