Theresa K Kelso, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35S1002377 Issued in NJ

Practice address

420 Boulevard
Suite 208
Mountain Lakes, NJ 07046-1742

Phone

(973) 299-2888

Fax

(973) 299-2876

NPI assigned

Oct 24, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083797682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD",
            "address_2": "SUITE 208",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461742",
            "telephone_number": "973-299-2888",
            "fax_number": "973-299-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD",
            "address_2": "SUITE 208",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461742",
            "telephone_number": "973-299-2888",
            "fax_number": "973-299-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELSO",
        "first_name": "THERESA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35S1002377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS IDENTIFIER",
            "identifier": "048786",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX IDENTIFICATIO",
            "identifier": "223688014",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BEH. HEALTH",
            "identifier": "4514820",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexander S Kade, P.T.
• Michael Kalin
• Deniz Kalyon, PSYD
• Kimberlee June Karpack, LPC
• Randi Kaufmann
• Lakeland Cardiology Center, PA
• Lakeside Physical Therapy LLC
• Peggy Elizabeth Lambe, MS, OTR/L
• Geraldine Lane, LPC
• Christopher Langford, LPC

• Clinical Psychologist in Mountain Lakes, NJ
• Providers in Mountain Lakes, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.