Provider Demographics
NPI:1023022845
Name:TAYLOR, KELLY J (MS,MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS,MA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-679-5222
Mailing Address - Fax:508-676-5671
Practice Address - Street 1:386 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-679-5222
Practice Address - Fax:508-676-5671
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P31635Medicare UPIN
P31635Medicare UPIN