Provider Demographics
NPI:1427463967
Name:KELLY, RONALD (MA)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:ALLEN
Other - Last Name:PORRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 JUNE AVE
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-8963
Mailing Address - Country:US
Mailing Address - Phone:570-640-0990
Mailing Address - Fax:
Practice Address - Street 1:340 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-2127
Practice Address - Country:US
Practice Address - Phone:800-200-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health