Provider Demographics
NPI:1023555471
Name:EDWARDS, KELSEY LINK (MS)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LINK
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:LINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:158 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2829
Mailing Address - Country:US
Mailing Address - Phone:605-359-6084
Mailing Address - Fax:
Practice Address - Street 1:10 BRIDGE ST STE 300
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1269
Practice Address - Country:US
Practice Address - Phone:978-453-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health