Provider Demographics
NPI:1093023517
Name:SMITH, KELLEY ANNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:ANNE
Other - Last Name:WHITTAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CPRP
Mailing Address - Street 1:290 TURNPIKE RD STE 5-138
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2843
Mailing Address - Country:US
Mailing Address - Phone:508-418-6608
Mailing Address - Fax:508-475-9396
Practice Address - Street 1:290 TURNPIKE RD STE 5-138
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2843
Practice Address - Country:US
Practice Address - Phone:508-418-6608
Practice Address - Fax:508-475-9396
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1212891041C0700X
CT84481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical