Provider Demographics
NPI:1386991040
Name:KELLY, CAROLINE MARIE REESE (PSYD)
Entity type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:MARIE REESE
Last Name:KELLY
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 1:101 POINT LOBOS AVE
Mailing Address - Street 2:APT 308
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1470
Mailing Address - Country:US
Mailing Address - Phone:720-270-8684
Mailing Address - Fax:
Practice Address - Street 1:25 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1436
Practice Address - Country:US
Practice Address - Phone:719-327-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist