Provider Demographics
NPI:1699972620
Name:ALBERTSON KELLY, JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:ALBERTSON KELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:ALBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 VALLEYWOOD CT W
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-862-7247
Mailing Address - Fax:
Practice Address - Street 1:811 WEST JERICHO TURNPIKE
Practice Address - Street 2:SUITE 106E
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-9850
Practice Address - Fax:631-265-9852
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100123103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist