Kelly, Samuel E

Kelly, Samuel E is an sole proprietor health care provider with primary practice located at 2901 W Oakland Park Blvd Ste A1, Oakland Park FL 33311-1243. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Kelly, Samuel E can be contacted via phone (954) 202-9334.

Contact Information

Primary practice address
2901 W Oakland Park Blvd Ste A1 Oakland Park FL 33311-1243
Phone: (954) 202-9334
Fax: (954) 202-7912
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH3876 Florida

Profile Details

NPI number 1669797171
LBN Legal business name Kelly, Samuel E
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 29th, 2010
Last updated Dec 7th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669797171 NPPES
Florida MEDICAID 676033396
Florida MEDICAID 676033398

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