Provider Demographics
NPI:1699945766
Name:DEIACO, KELLI J (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:J
Last Name:DEIACO
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 W END TRL UNIT 141
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-5003
Mailing Address - Country:US
Mailing Address - Phone:610-462-5585
Mailing Address - Fax:
Practice Address - Street 1:16287 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3614
Practice Address - Country:US
Practice Address - Phone:302-703-6332
Practice Address - Fax:302-827-4856
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004790101YP2500X
DEB1-0011334103TC0700X
PAPS018210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional