Provider Demographics
NPI:1447304795
Name:CONROY KEGLEY, A. ELISE (PHD)
Entity type:Individual
Prefix:
First Name:A.
Middle Name:ELISE
Last Name:CONROY KEGLEY
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 1:416 E FORT DADE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2615
Mailing Address - Country:US
Mailing Address - Phone:352-544-0910
Mailing Address - Fax:352-754-8411
Practice Address - Street 1:416 E FORT DADE AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2615
Practice Address - Country:US
Practice Address - Phone:352-544-0910
Practice Address - Fax:352-754-8411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0000323103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist