Provider Demographics
NPI:1851410542
Name:KELLY, JANICE MARIE (PHD)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SOUTH LANG AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15208
Mailing Address - Country:US
Mailing Address - Phone:412-889-8571
Mailing Address - Fax:
Practice Address - Street 1:321 SOUTH LANG AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15208
Practice Address - Country:US
Practice Address - Phone:412-889-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006967L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE764837Medicare ID - Type Unspecified