Provider Demographics
NPI:1033766589
Name:KELLY, SARAH SMITH (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:SMITH
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 FALMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4864
Mailing Address - Country:US
Mailing Address - Phone:207-780-5639
Mailing Address - Fax:
Practice Address - Street 1:96 FALMOUTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4864
Practice Address - Country:US
Practice Address - Phone:207-780-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional