Roger Bruce Kelly, MA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS005648L Issued in PA

Practice address

525 N 12TH St Ste 100
Lemoyne, PA 17043-1244

Phone

(717) 730-0733

Fax

(717) 730-0696

NPI assigned

Sep 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Center for Hope and Healing, LLC

  • Mental Health Counselor
  • Camp Hill, PA
  • NPI 1831543511
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1720187321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N 12TH ST STE 100",
            "city": "LEMOYNE",
            "state": "PA",
            "postal_code": "170431244",
            "telephone_number": "717-730-0733",
            "fax_number": "717-730-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N 12TH ST STE 100",
            "city": "LEMOYNE",
            "state": "PA",
            "postal_code": "170431244",
            "telephone_number": "717-730-0733",
            "fax_number": "717-730-0696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4349 Carlisle Pike",
            "address_2": "Ste 101",
            "address_purpose": "LOCATION",
            "city": "Camp Hill",
            "state": "PA",
            "postal_code": "170114252",
            "country_code": "US",
            "telephone_number": "717-775-3380",
            "fax_number": "717-775-3382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ROGER",
        "middle_name": "BRUCE",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS005648L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica R Johnson, P.T.
• Sonya C Johnson, RPH
• Gary W Karkuff, P.T.
• Kay LLC
• Ashley Ann Kelly
• Keystone Pain and Rehabilitation, LLC
• Dale King
• Megan Kirsch
• Alyssa Marie Klinedinst, PTA
• Elena Kozochonok, M.D

• Psychologist in Lemoyne, PA
• Providers in Lemoyne, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.