Provider Demographics
NPI:1447530316
Name:KELLY, JAMES M (PHD, LSW)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:KELLY
Suffix:
Gender:M
Credentials:PHD, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3109
Mailing Address - Country:US
Mailing Address - Phone:412-303-2506
Mailing Address - Fax:
Practice Address - Street 1:3333 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3109
Practice Address - Country:US
Practice Address - Phone:412-303-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW010077L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker