| NPI | 1811185440 |
|---|---|
| Former Name | MICHELE ROSE KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 014520) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 014520-01) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2022-07-21 |