Provider Demographics
NPI:1386878270
Name:KELLEY, DONNA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 KING RD
Mailing Address - Street 2:P.O. BOX 400
Mailing Address - City:IMMACULATA
Mailing Address - State:PA
Mailing Address - Zip Code:19345-9903
Mailing Address - Country:US
Mailing Address - Phone:610-647-4400
Mailing Address - Fax:610-647-2324
Practice Address - Street 1:1145 KING RD
Practice Address - Street 2:
Practice Address - City:IMMACULATA
Practice Address - State:PA
Practice Address - Zip Code:19345-9903
Practice Address - Country:US
Practice Address - Phone:610-647-4400
Practice Address - Fax:610-647-2324
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSO16631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist