Provider Demographics
NPI:1699302760
Name:BICKFORD, KELSEY FAY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:FAY
Last Name:BICKFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 CRUGER AVE APT 5N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1536
Mailing Address - Country:US
Mailing Address - Phone:518-524-3190
Mailing Address - Fax:
Practice Address - Street 1:2187 CRUGER AVE APT 5N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1536
Practice Address - Country:US
Practice Address - Phone:518-524-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist