Provider Demographics
NPI:1053641399
Name:FOLEY, KIELY LYNN (PMHNP-BC, LCSW)
Entity Type:Individual
Prefix:
First Name:KIELY
Middle Name:LYNN
Last Name:FOLEY
Suffix:
Gender:F
Credentials:PMHNP-BC, LCSW
Other - Prefix:
Other - First Name:KIELY
Other - Middle Name:LYNN
Other - Last Name:GEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-661-6654
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:123 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3848
Practice Address - Country:US
Practice Address - Phone:207-761-2200
Practice Address - Fax:207-761-2108
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC122491041C0700X
MECNP121041363LP0808X
MERN58534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400194336Medicare PIN