Provider Demographics
NPI:1083136493
Name:HARRIES, KELLIE J (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:J
Last Name:HARRIES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:NORTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 BILLERICA RD
Mailing Address - Street 2:#4100
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:888-896-5227
Mailing Address - Fax:978-616-7863
Practice Address - Street 1:321 BILLERICA RD
Practice Address - Street 2:#4100
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824
Practice Address - Country:US
Practice Address - Phone:888-896-5227
Practice Address - Fax:978-616-7863
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2000103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst