Provider Demographics
NPI:1073897732
Name:CAROLAN, KELSI JUSTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:JUSTINE
Last Name:CAROLAN
Suffix:
Gender:F
Credentials:LCSW
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:COGNITIVE NEUROLOGY UNIT, KIRSTEIN 2, BIDMC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:COGNITIVE NEUROLOGY UNIT, KIRSTEIN 2, BIDMC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2173001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical